Using Medicaid’s Early and Periodic Screening, and Diagnostic and Treatment (EPSDT) to Address Social Determinants of Health
Healthy children are critical to North Carolina’s future. When health needs go unaddressed, they not only can result in high-cost emergency medical care, but generate broader costs. When families experience health needs and can’t work or attend school, entire communities suffer. This is why it is important for North Carolina to improve its health outcomes for our children. Currently the state ranks 33rd for overall child well-being in the nation according to data collected in the 2017 Kids Count Data Book.
Preventative screenings ensure health conditions are identified early and health behaviors are supported, increasing the likelihood of better health outcomes. Using an “upstream” approach that places emphasis on preventative health services can ensure child health priorities are maintained in a cost-effective way and minimize greater harm to health with chronic or severe health conditions. Going upstream extends beyond health care to considerations of factors such as the quality of housing, adverse childhood experiences, school attendance, and access healthy foods, all of which are connected to health outcomes. These social determinants of health are considered fundamental to achieving our priorities for healthy children and family wellbeing, especially when considered alongside how systems have created barriers over time for people of color in economic opportunity and access to systems that provide healthier outcomes.
Medicaid—the country’s system delivering primary care to those who otherwise would not have health insurance—was founded to achieve greater population health, recognizing the role of access and care in driving better health outcomes. Medicaid has proven effective at reducing health care costs to the private system, improving health outcomes for children and families with low-incomes, and developing new models that inform a community-health approach. Yet, data suggests that in the last year only one-third of children with Medicaid received a well-child screening.
One of the mandated guidelines that works to ensure North Carolina’s children get the care they need, when they need it, is the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit of North Carolina Health Check (Child Medicaid). Under EPSDT, states are required to cover a broad array of medically necessary and rehabilitative services for children under the age of 21. Successful EPSDT implementation is a component of a robust preventative care model that recognizes social determinants of health and seeks to address them.
This report provides an overview of North Carolina’s EPSDT program and examines the effectiveness of the program as it relates to identified child health priorities and social determinants of health. By highlighting best practices at both the state and national level, this report offers practice and policy models for how EPSDT delivery can be improved or modified to address social determinants of health and ultimately improve child health outcomes.