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EPSDT & the System of Care

MOUs to Improve Linkages between Medicaid Managed Care Organizations and Public Health Agencies Serving Children 

Printer-friendly MOUs to Improve Linkages between Medicaid Managed Care Organizations and Public Health Agencies Serving Children (19 KB)

Managed care structures affect how public health agencies carry out their community-wide public health responsibilities. 

• The Maternal and Child Health Library at Georgetown University developed a State MCH-Medicaid Coordination Toolkit: Title V and Title XIX Interageny Agreements, based on a national review.  A print-friendly PDF and an on-line Web-based version are available.  

State Title V MCH programs can and should help local public health agencies learn about managed care and the MOU process. In terms of EPSDT, MOUs might define interaction related to case management, data reporting, immunization billing, children with special health care needs, and so forth.

Studies by the GWU-Center for Health Services Research and Policy indicate that:

• MOUs play a useful role in establishing working relationships between public health agencies and MCOs.
  MOUs often do not address core public health functions beyond the provision of personal health services.
• While MOUs often describe billing arrangements for covered services delivered by a local health department, such arrangements are often not in use.

MOUs have a limited impact on resolution of certain fundamental issues and do not typically improve:

• State and local public health agencies’ access to data needed for community-wide disease surveillance (e.g. immunization registries).
• MCO participation in larger community efforts to control public health threats (e.g., communicable disease outbreaks, lead exposure).
• MCO understanding of quality improvement standards advocated by public health agencies as a means of community-wide public health protection.

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Linkages to Other Public Programs 

Printer-friendly Linkages to Other Public Programs (19 KB)

Children with Special Health Care Needs Programs
Many children identified by Title V Agencies as CSHCN are Medicaid recipients.Program linkages can improve care, reduce expenditures, and better support families.

• An EPSDT Check list prepared by the National Health Law Project, which can be used to guide planning for CSHCN.
• Additional resources on how how EPSDT fits into the system of care can be found at the National Health Law Program EPSDT resource page.
• Policy brief discusses Medicaid and EPSDT, as well as home and community based services for CSHCN

Child Welfare Programs, including Foster Care
Children entering the foster care system are entitled to Medicaid and an initial or periodic EPSDT screen. States have a variety of approaches to fulfilling this obligation.

IDEA Part C Early Intervention Program
Under the federal Individuals with Disabilities Education Act (IDEA) Part C program, states provide early intervention services for infants and toddlers (birth to age 3) that have or have a high risk for experiencing developmental delays. Some children qualify for both Medicaid and IDEA financing. Medicaid financing for certain services provided to a child and family under a Part C is permitted by federal law.  
 
Head Start Programs
A majority of children served in Head Start programs are Medicaid eligible. The Federal Head Start program calls for linkages and coordination, as part of Head Start health services. The Administration for Children & Families provide links of state resources by region.

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