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We investigated enforcement of mental health benefits provided by California Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Enforcement, compelled by a consumer-driven lawsuit, resulted in an almost 4-fold funding increase over a 5-year period.
We evaluated the impact of enforcement on outpatient treatment intensity (number of visits per child) and rates of emergency care treatment. Using fixed-effects regression,weexamined the number of outpatient mental health visits per client and the percentage of all clients using crisis care across 53 autonomous California county mental health plans over 32 three-month periods (quarters; emergency crisis care rates) and 36 quarters (outpatient mental health visits).
Enforcement of EPSDT benefits in accordance with federal law produced favorable changes in patterns of mental health service use, consistent with policy aims. (Am J Public Health. 2007; 97:1951-1956. doi:10.2105/AJPH. 2006.094771)
FOR THE ROUGHLY 20% OF US children and adolescents who have a mental disorder and whose ability to successfully function is at least mildly impaired, the state-federal Medicaid program is a major source of mental health care financing.1 Children eligible for Medicaid are especially vulnerable; they include children from families with annual incomes below 100% of the federal poverty level and those who have been removed from their homes and made dependents of the court. Public social services-especially the child welfare system, which cares for children who have experienced abuse or neglect-are important gatekeepers of the public mental health system.2
Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) program is an especially important source of public financing of mental health care. Enacted in 1967 as an amendment to Title XIX (Medicaid) and enhanced in 1989 and 1990, EPSDT calls for integrated care covering a wide range of screening, diagnostic, and treatment services for children and youths meeting state Medicaid criteria (K. Olson, J. Perkins, and T. Pate, unpublished data, 1998). Since its enhancement in 1989, the program is required to pay for comprehensive pediatric screening services, as well as for federally allowable health and mental health care services for conditions detected through EPSDT screening. These latter services must be provided to those younger than 21 years-old and enrolled in Medicaid, regardless of whether or not those services are otherwise reimbursed under the state's Medicaid program.3 States are also required to inform...