CMS publishes new guidance on Medicaid, CHIP coverage: 7 things to know

CMS is providing states new guidance to ensure states comply with required Medicaid services for children. 

Medicaid programs are required to provide more comprehensive coverage for children than for adults. 

State Medicaid programs must comply with Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, requirements, which lay out required services for children receiving Medicaid or CHIP benefits. 

The new guidance, published Sept. 26, is the most comprehensive EPSDT guidance CMS has issued in a decade, according to a news release. The Bipartisan Safer Communities Act directed CMS to publish new requirements on EPSDT requirements. 

The guidance provides states with strategies and best practices to maintain compliance with EPSDT laws. The report lays out recommendations for promoting awareness and accessibility of comprehensive services for children. The report also focuses on expanding the workforce treating children with Medicaid, and improving care for children with special needs. 

Here are 7 things to know:

1. States should use clear language in communications to families and providers about services available for children with Medicaid. 
   
   
2. For states using managed care plans, CMS recommends incentivizing plans to provide members with assistance scheduling services. 
   
   
3. CMS recommends managed care plans document their consideration of EPSDT requirements, and offer specific training on the rules to providers. 
   
   
4. The agency recommends adding reimbursement for peer support and other non-licensed practitioners in Medicaid. This frees up social workers, psychologists and psychiatrists to address more complex issues. 
   
   
5. CMS recommends states allow providers to deliver services via telehealth, especially in rural areas. 
   
   
6. States should prioritize integrated primary and behavioral care to treat children with mild to moderate behavioral conditions, and only rely on inpatient and residential behavioral health settings when necessary. 
   
   
7. Medicaid agencies should develop collaborative relationships with child welfare agencies to ensure children in foster care receive EPSDT services.