Recommended Citation
L. Kate Mitchell,
The Promise and Failures of Children's Medicaid and the Role of Medical-Legal Partnerships as Monitors and Advocates,
30 Health Matrix
175
(2020)
Available at:
https://scholarlycommons.law.case.edu/healthmatrix/vol30/iss1/6
Abstract
For decades we have known that access to early and preventive diagnosis and treatment can dramatically alter the course of a child’s life. Because of this knowledge, immediately after Congress enacted Medicaid, it created the Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, program. EPSDT requires broad, holistic, and preventive care to correct or ameliorate health defects identified in Medicaid-eligible children. This coverage currently extends to 2 out of 5 children in the United States, and 47 percent of children with special health care needs. Because of the broad parameters of coverage mandated by EPSDT, Medicaid-eligible children should receive more enhanced access to care than adults on Medicaid, including any and all necessary medical care indicated by their health care providers. Tragically, for children like Savannah, a Medicaideligible girl with complex medical needs in Michigan, failures in EPSDT implementation resulted in unmet needs and dire consequences. Savannah was denied access to physical therapy, occupational therapy, and speech therapy critical to maintaining her ability to walk, feed herself, and function with some independence. As states have modified their Medicaid plan guidelines and transitioned to privatized Medicaid in an effort to cut growing costs, coverage gaps for vulnerable children like Savannah have intensified, leaving parents and providers feeling helpless and unable to give their patients and children the care they need. Medical-legal partnerships—interdisciplinary collaborations between health care providers and lawyers—are well suited to monitor EPSDT compliance, engage medical providers in informed patient advocacy, facilitate exchange of information regarding failures in coverage, and hold Medicaid programs accountable to low-income children. This article will review the history of the public health insurance system, outline the current legal mandates and landscape of EPSDT, and discuss the role that medical-legal partnerships can play in ensuring that EPSDT fulfills its purpose.