Medicaid policy: Improving comprehensive well-child care

The Medicaid Early and Periodic, Screening, Diagnostic and Treatment (EPSDT) benefit has long provided for an assessment of both general and mental health at the well-child visit. Yet, few states have taken any steps to ensure that the mental health assessment component is provided, and available evidence indicates that few beneficiaries receive this service. This is despite epidemiological research showing that young people from disadvantaged socio-economic backgrounds, such as those enrolled in Medicaid, are at significantly higher risk for mental illnesses. By failing to offer an evidence-based mental health assessment to these youth, Medicaid programs are missing an opportunity to improve health status and related outcomes through early identification and intervention. The Patient Protection and Affordable Care Act (PPACA) is set to extend Medicaid coverage to approximately 7 to 8 million additional individuals under the age of 18 in 2014. At the same time, eligibility for Medicaid has been extended to cover adults up to 133 percent of the federal poverty level, also beginning in 2014. These changes in eligibility will create a new incentive to improve prevention and early identification of chronic disease, such as depression. Beneficiaries will be eligible for public health coverage for a greater length of time, making it more likely that Medicaid programs will undertake efforts to reduce costs through an increased focus on prevention. Policy options to improve receipt of an evidence-based mental health assessment during the Medicaid well-child visit will be presented.