Today, more than 30 million children and teens in the United States are enrolled in the Medicaid program or covered by state Medicaid expansion programs, making Medicaid a critical player in determining the health status of our nation’s youth.
 

Medicaid Benefits Include Mental Health Screening

The Medicaid program provides for coverage of regular well-child visits, including a comprehensive assessment of both physical and mental health. This benefit is outlined as part of the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which describes services that must be offered to all youth up to age 21.

Importantly, states must offer these comprehensive screenings and any services medically necessary to ameliorate a condition identified by screening – whether or not these services would otherwise be covered.

The EPSDT mandate to provide comprehensive preventive screening, including a mental health assessment, is especially crucial to the health of young people. Approximately 11 percent of youth suffer from mental illness that causes significant functional impairment in daily life, but only about a third of these youth receive services.
 

Few Youth are Offered Evidence-Based Screening

Despite the requirement to offer a mental health assessment at the Medicaid well-child visit, evidence suggests that few states have taken steps to ensure that this service is offered to beneficiaries. There is currently no required reporting relating to the rate at which mental health screening is offered to youth. However, reports suggest very low rates of access (see TeenScreen fact sheet).

A 2001 report from the Government Accountability Office cited an external quality review of one state Medicaid program, which concluded that just 27 percent of youth received a mental health screen. A 2010 report from the Department of Health and Human Services Office of Inspector General found that nearly 60 percent of children across nine states who attended a Medicaid well-child visit were not offered a complete screening.

This is a missed opportunity to improve outcomes and reduce spending related to mental illness in youth, which the Institute of Medicine estimated at $247 billion in 2007 dollars.
 

TeenScreen National Center’s Federal Policy Recommendations

To improve the rate at which youth are offered a mental health screen using an evidence-based tool at the Medicaid well-child visit, the TeenScreen National Center recommends:

• Formal guidance from the Centers for Medicare and Medicaid Services (CMS) to clarify that mental health screening should be provided at all well-child visits using an evidence based tool.
• Modification of the CMS Form 416 reports submitted by state Medicaid programs to require reporting on the rate at which youth are offered a mental health assessment.
• Technical assistance and best practices resources/guidelines on effectively implementing mental health screening for states.
• Measuring the rate of adolescent depression screening as part of federal quality reporting efforts, such as the core set of pediatric quality measures authorized by the Children’s Health Insurance Program Reauthorization Act (CHIPRA). See Quality Improvement for more.

For more in depth information, please see the TeenScreen National Center white paper entitled Adolescent Mental Health Checkups in Medicaid.

Update: In 2009, CMS held two listening sessions on EPSDT to gather input on improvements that could be made to the benefit. Individuals representing state Medicaid programs and national children’s health organizations were invited to participate. Following those listening sessions, CMS convened a National EPSDT Improvement Workgroup in late 2010 to consider how to move forward with improvements. The TeenScreen National Center is participating on the Behavioral Health Sub-Workgroup of the National EPSDT Improvement Workgroup. This work is ongoing in 2011.
 

Best Practices: Massachusetts Case Study

For a look at one state Medicaid program’s efforts to offer evidence-based mental health screening at all well-child visits, please see our page on the Massachusetts Experience.

Continue to: The Massachusetts Experience
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