An estimated 25 percent of all school children in the United States have some type of vision problem significant enough to affect daily life and school performance. Similarly, despite the proliferation of hospital-based newborn hearing screening programs, a significant number of children with possible hearing loss are not receiving prompt diagnosis and treatment. Children enrolled in Medicaid are entitled to a comprehensive array of preventive and ameliorative care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
As states have increasingly turned to managed care entities to fulfill their Medicaid administrative obligations, these companies are charged with affirmative duties to ensure that children receive EPSDT benefits. The articles and resources below examine approaches to improving delivery of vision and hearing services in a managed care setting.
For years, a federal policy prevented Medicaid reimbursement for many services provided in schools, making it a lot harder for schools with limited financial resources to make necessary health care available for kids. But in 2014, the federal Centers for Medicare and Medicaid Services (CMS) reversed the policy blocking reimbursement, which means that schools should be able to provide many more necessary check-ups and treatments to kids who need them.
The Network was contacted by a public health practitioner looking for research on vision and hearing problems in low-income children, and access to screening and other services.
This resource suggests model contract provisions for coverage of vision and hearing services in Medicaid managed care.
Thursday, May 14 at 1 p.m. ET. The Medicaid program offers low-income children a comprehensive array of preventive, diagnostic, and treatment services, known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This webinar will focus on the role that EPSDT can play in addressing children’s vision and hearing problems. View the playback.
Children enrolled in Medicaid are entitled to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This report surveys states’ contracts with managed care entities to document the extent to which EPSDT services address children’s hearing and vision services and how these services are monitored.
The Medicaid Early and Periodic Screening, Diagnostic and Treatment service (EPSDT) is a comprehensive benefit available to children and youth under age 21 who are enrolled in Medicaid. Read more about this benefit, how the service addresses screening and treatment, education about EPSDT and state reporting.
Additionally, these pages from the Centers for Medicare and Medicaid provide further information on EPSDT benefit.