EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT AND MANAGED CARE

This paper presents evidence on the performance of Medicaid managed ca re organizations (MCOs) in providing Early and Periodic Screening, Dia gnosis, and Treatment (EPSDT) services to children under age 21. State s face considerable challenges in integrating EPSDT into managed care. For example, MCOs rarely offer all services required under federal la w. Also, MCOs often are unable to meet state reporting requirements. O n the other hand, MCOs offer children a medical home, often for the fi rst time, that may encourage timely preventive care. The literature ge nerally shows no differences in the performance of MCOs relative to tr aditional FFS providers in the EPSDT participation rate. Future needs include improving the specificity of contract language, more precisely defining the EPSDT benefit package, evaluating the adequacy of EPSDT payments, monitoring the capacity of MCO provider networks, establishi ng the effectiveness of outreach and enabling services, developing sta ndardized MCO reporting requirements, documenting program outcomes, an d assessing benchmarks for accountability.