Biden-Harris Administration Releases Historic Guidance on Health Coverage Requirements for Children and Youth Enrolled in Medicaid and CHIP

September 27, 2024

Read the full CMS press release

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and Children's Health Insurance Program (CHIP) coverage - nearly half of the children in this country - receive the full range of health care services they need. Under Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, eligible children and youth are entitled to a comprehensive array of prevention, diagnostic, and treatment services - including well-child visits, mental health services, dental, vision, and hearing services.

Children with a wide range of needs benefit from EPSDT services, including children with developmental and other disabilities, children who have complex medical conditions, and children who need behavioral health services. Families depend on EPSDT services to support their children in school, at home, and in the community from birth through age 21. The EPSDT guidance includes a section, "Improving Care for Children with Specialized Needs," to specifically address the needs of the children and youth ACL and our networks serve.

The new guidance provides an overview of EPSDT requirements and how states can fulfill them. It discusses policies, strategies, and best practices to maximize health care access and utilization for EPSDT-eligible children and can serve as an important advocacy tool for ACL's networks, people with disabilities, and their families.