Audit of Medicaid Managed Care EPDST Behavioral Health Services for Children

OBJECTIVE

Mental health in childhood includes reaching developmental and emotional milestones and learning healthy social skills and coping skills for when problems arise. Medicaid's mandatory early and periodic screening, diagnostic, and treatment (EPSDT) benefit requires that children under age 21 who are enrolled in Medicaid receive all medically necessary services, including behavioral health services, which include services for mental and substance use disorders. Many States include coverage of behavioral health services for children and youth in their Medicaid State plans and through various Medicaid managed care waivers. We will determine the extent to which children enrolled in Medicaid received EPSDT medical screenings and, if diagnosed with a behavioral health condition, whether behavioral health treatment services were provided. We will also review whether States and managed care organizations met Federal and State requirements for providing EPSDT behavioral health services.

TIMELINE