IV. Priority Recommendations (continued)
6 well-child visits in the first 15 months of life is above the national average and the level of the top quartile in performance among all 50 states. In addition, Pennsylvania is among 8 states where Medicaid requires maternal depression screenings as part of a well-child visit (others include Georgia, Maryland, Michigan, Mississippi, New Jersey, New Mexico, Washington). A smaller number of states, including Pennsylvania, use performance measures to track maternal health screenings during well-child visits (including Oregon, Rhode Island, and Wisconsin). Measuring performance is an important aspect of Medicaid managed care arrangements and is detailed in state contracts and quality initiatives with managed care organizations (MCOs), physicians, and other service providers, including EI. What does research say about this topic? Medicaid’s role in financing Part C: Since the inception of the Part C EI program in 1986, the intent of federal law has been for states to finance EI services through a variety of public and private sources. In 1988, federal law was clarified to state that Medicaid could be used to finance Part C EI services that are part of the child’s IFSP. (Public Law 100-360) The Early Periodic Screening, Diagnostic, and Treatment (EPSDT) child health benefit, requires state Medicaid programs to cover all services “necessary…to correct or ameliorate… physical and mental… conditions.” Under this broad federal definition, Medicaid can and does finance EI services. Medicaid is the only source of health coverage for nearly four in ten children in Part C EI and other IDEA special education programs. Surveys and studies point to a difference in performance between states that use Medicaid financing and those that do not, in terms of both access to and quality of Part C EI services. (Centers for Medicare and Medicaid Services EPSDT; Williams & Musumeci, 2021; Musumeci & Chidambaram, 2019; Vail et al., 2018 https://doi.org/10.1177/1053815118771388; Centers for Medicare and Medicaid Service, 2014 Fox et al,. 1998; Federal Regulations 34 CFR Section 303.510)
Medicaid and Part C coordination and partnerships: To ensure children receive timely access to services, Medicaid and Part C EI agencies must design processes for both health and EI providers to deliver developmental screening, referral, and follow-up services in an effective and coordinated manner. Strong partnerships between Medicaid and EI agencies can facilitate coordination of services and efficiency of processes, helping Part C EI programs adhere to federally mandated timelines and enabling children and families to receive more timely services. Strong partnerships between these agencies are also needed to avoid excess costs that result from duplicative services. States are required under federal law to have formal interagency agreements that define fiscal responsibilities. (Williams & Musumeci, 2021; Johnson & Bruner, 2018; Heider, 2016; Health Resources and Services Administration EPSDT Interagency Partnerships) Medicaid Home and Community-Based Services: In every state, Medicaid is the primary source of coverage for home and community-based services (HCBS) for people—including children—with disabilities, often under waiver programs. These HCBS help to ensure that children can live at home with their families rather than living in more costly institutions. In every state, various state options and waivers are used to structure Medicaid financing of HCBS. This began with the Katie Beckett program, signed into law in 1981 that enables HCBS for children up to age 19 who would otherwise have required institutionalization to become Medicaid eligible. In 2021, the American Rescue Plan Act (ARPA) made important changes including an increased Medicaid Federal Medical Assistance Percentage (FMAP) matching for states to strengthen the direct care workforce, eligibility, and the quality of HCBS. Further federal policy changes are under discussion. (Centers for Medicare and Medicaid Services HCBS; Centers for Medicare and Medicaid Services 1915(c) Waivers; Watts et al., 2020; MACPAC, 2019; Leslie et al., https://doi.org/10.1097/MLR.0000000000000621)
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