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Dr. Roy Maynard Discusses EPSDT for Disadvantaged Children

Maynard, Roy 2Roy C. Maynard, M.D., is the Medical Director for PHS. He serves as PHS’s clinical leader, working with the team to provide consultation and advice to ensure quality and effective care to children and their families in their own homes. He also leads implementation of clinical policies, procedures and programs to further enhance the best possible care for each child. He is a Neonatologist and Pediatric Pulmonologist, and serves as a staff physician at Children’s Hospitals and Clinics in Minneapolis, Minn. 

Medicaid is a joint partnership between the federal government and states to provide health care funding for low-income individuals. The Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) program is part of Medicaid and applied to children to improve child health. Since its implementation in 1967, this program has been present in every state and designed to improve the health of low-income children by financing pediatric services.

Step By Step, Improving Child Health

There are five elements of the program:

  • Early hopes to capture medical problems at birth or shortly after to intervene and optimize long term outcomes.
  • Periodic is the second element and involves age appropriate health care check-ups at predetermined intervals.
  • Screening is more comprehensive and hopefully will identify problems that may be associated with physical, mental, developmental, dental, hearing or vision. Specific screening recommendations for Minnesota’s program are available here. When a concern is identified in the screening process, the fourth element,
  • Diagnosis, comes into play. Diagnostic testing is initiated that will ultimately lead to the final element,
  • Treatment. Treatment should not just treat the acute condition or illness but also prevent worsening of the disability or medical condition.

Variance by State 

Medically necessary diagnostic tests and treatments should be covered under Medicaid Medical Assistance. Currently however, there is no specific federal definition to define the standard of medical necessity. Each state is left on its own to define how to “not only treat existing conditions but prevent development or worsening of condition, illnesses or disabilities”. This accounts for the variations in the programs from state to state.

Two other essential components of EPSDT for Medicaid recipients include assuring availability and accessibility of health care resources and also helping parents/guardians and recipients to effectively utilize these services. The latter may involve help with scheduling appointments and transportation to keep those appointments.

Title V Assures Access

In 1935 the Social Security Act enacted a health care “safety net” program known as Title V. This maternal and child health program has undergone several modifications since then. Title V and EPSDT work together to the benefit of Medicaid recipients. This collaboration enhances access and enrollment, coordination of resources and also is charged with preventing duplication of services. Also included is data collection to measure and help improve outcomes.

MN Expands Medicaid

Improving healthcare outcomes is part of ObamaCare Medicaid Expansion. Minnesota is one of the states opting to expand its Medicaid program. Ultimately the goal is to provide healthcare for the previously uninsured, increase the quality of health of the individual, decrease the utilization of expensive emergency services and ultimately decrease the rising costs associated with unpaid hospital bills by the uninsured. Like Medicaid and EPSDT, Pediatric Home Service is dedicated to improve health care by taking care of the child.

Originally published: April 25, 2014