There was significant public outcry over the possibility of dissolving the Prevention and Public Health Fund and eliminating essential health benefits under the American Health Care Act (AHCA)—both proposals were also included in the Senate’s Better Care Reconciliation Act (BCRA).
Yet the treatment of Medicaid’s Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) benefit has received far less attention even though the AHCA and BCRA would make it harder for many children to receive the care they need—including services related to substance misuse and lead poisoning.
The BCRA would permit states to convert Medicaid to a block grant for certain populations, including children. States approved for this block grant option would no longer be required to cover the EPSDT, which allows children to receive comprehensive screenings (including for substance use disorders), immunizations, laboratory tests (including blood lead level testing), vital health education, and vision, dental, and hearing services. This benefit was introduced in 1967 when the military began experiencing unusually high draftee rejection rates due to untreated childhood medical issues.
EPSDT ensures children have access to the services they need to be healthy and excel at school—and, research demonstrates time and again that healthy kids are better learners.
Since EPSDT was created, it has benefited low-income children who are disproportionately affected by obesity, increased blood lead levels, asthma, trauma, adverse childhood experiences and other health problems.
In essence, EPSDT:
- Encourages the identification of potential health problems early in a child’s life, thereby preventing children from developing costly and potentially chronic conditions;
- Allows for periodic and regular doctor’s visits;
- Supports developmental, physical, and mental health screenings;
- Requires diagnostic follow-ups if a risk is found; and
- Ensures treatment is provided for any health risk.
If a condition is discovered, the EPSDT benefit covers the health services necessary for getting the child well—regardless of whether the state’s Medicaid program would have covered the treatment. At its core, EPSDT provides expansive, needed benefits to some of our most vulnerable children to stop health conditions from becoming more significant and costly during adolescence or adulthood.
EPSDT has been helping children for decades. Children with the EPSDT benefit access well-child visits as often as privately insured children and more often than uninsured children. The benefit is especially important for the 1.3 million children with disabilities who are enrolled in Medicaid. For these children, according to the Kaiser Family Foundation, EPSDT “provides more comprehensive coverage than the typical private insurance plan and increases access to needed services that improve the quality of daily life.”
In short, EPSDT provides earlier and better care than would otherwise be available for sick and vulnerable children. It helps kids stay healthy and reach their full potential.
When the U.S. Senate puts together their package to replace the Affordable Care Act (ACA), they must ensure that children are covered and able to access the services we know will keep them healthy, happy and productive.
This will take a significant revision to the BCRA, which did not include any EPSDT requirements. As the National Health Law Program put it recently, “a block grant in Medicaid is untenable for a variety of reasons… [it]would both limit funding for children’s services and also eliminate EPSDT. The result is that millions of children will face significant difficulties accessing and affording the services they may need to get and stay healthy, succeed in school, and grow up to be productive members of society.”
No health bill should make it harder for children to be healthy.