CHAPTER 3

Head Start's Role in EPSDT
 

---

Introduction

The health of children has been recognized as important by child developmental specialists, educators, and health professionals. Head Start programs are key links in improving child health because of the health component and because Head Start personnel are in regular contact with young children and parents.

This chapter describes the three major roles Head Start programs can play in EPSDT:
outreach, case management, and service delivery. EPSDT services may be part of an overall Head Start health program that draws on multiple funding sources (e.g. Medicaid, private insurance, and Head Start funds) and builds on existing community providers.

Outreach

Head Start programs provide information to Head Start families about the importance of preventive health care. As a part of health education to families and EPSDT outreach, Head Start programs can encourage participation in EPSDT. Key parts of an outreach strategy include: describing what EPSDT is, promoting the advantages of early detection and treatment, describing ways to participate, and listing the EPSDT and support services that are available. The following outreach activities can be conducted by Head Start:

• Contacting children and families by telephone or letter to inform them about EPSDT

 
• Organizing parent groups or individual parents to reach out and encourage other eligible parents to participate in Medicaid and EPSDT;

 
• Developing and distributing posters, booklets, and related educational materials that inform the community about the benefits of EPSDT;

 
• Conducting health fairs on child health which emphasize preventive health care and promote EPSDT;

 
• Helping families prepare an application for the program; and

 
• Scheduling appointments.

Many of these activities are a part of the health education and health services already provided by Head Start programs. Before developing a strategy for conducting EPSDT outreach activities, a Head Start program needs first to identify existing community outreach programs to prevent duplication of services. A good starting place is to contact the State Medicaid and Maternal and Child Health (MCH) agencies. Since State MCH programs are required to conduct a needs assessment, they have useful information on health care needs and resources throughout the State.
 
 

Travis just turned five years old Dan will enter kindergarten in the fall.  He   has attended Head Start for the past two years.  This year, while receiving a routine   Medicaid/EPSDT dental screening, Travis was found to have dental problems that   will require extensive treatment over the next few months.           During the spring, the Health Coordinator reviews his health records to make    sure all documentation of screenings, immunizations, and treatment (especially his   dental treatment) is included in his file.  She also talks to Travis' parents to find out   where Travis will be attending kindergarten.  The kindergarten is located in a school   district that is also a Medicaid provider.  The Health Coordinator and Travis' mother   contact the local school district to set up a meeting to discuss Travis' on-going dental   treatment.  Travis' mother signs the request to forward his records on to the school   district and, when the Head Start program ends for the year, the Health Coordinator   forwards the records.

Case Management

The purpose of EPSDT case management is to assist enrollees through the often confusing system of health and related services in their communities. Since EPSDT screening, diagnostic, and treatment activities are frequently not conducted at one time or in one place, case management is important to ensure that a child receives appropriate services on a timely basis. Among other activities, case managers:
 

Assist families in identifying and choosing providers;

Use the Head Start program as a resource in scheduling appointments and in providing transportation;

Facilitate contact between the EPSDT program and the family to verify what activities have taken place, to maintain records, and to assure a timely flow of information;

Conduct follow-up to assure children receive needed diagnosis and treatment; and

Help families maintain contact with providers, and

Provide ongoing counseling to answer questions and reduce fear and confusion.

Head Start programs are well suited to assist in the case management role. Head Start programs currently perform a variety of administrative tasks that are similar to case management services needed for EPSDT. Head Start programs should contact their Medicaid agency to .explore reimbursement for these activities.

Service Delivery

There are three basic roles for Head Start programs in delivering EPSDT services to children:

1) Providing screening and referrals;
2) Providing screening and some treatment services; and
3) Full-scale service provision.

To conduct EPSDT screening services at the Head Start program, Head Start must employ or contract with qualified health personnel who are Medicaid providers. In some States, Head Start programs may use nurses or nurse practitioners to conduct EPSDT screenings on-site. Children are referred to community providers for diagnostic and treatment services when such services are not available at the Head Start program.

In order for Medicaid to pay for services provided by Head Start, there must be a provider agreement between the State and the actual provider of services. If the Head Start program employs health professionals, the Head Start program may qualify as the provider, bill Medicaid, and receive payment. Where the Head Start program contracts with the necessary health professionals to provide discrete Medicaid services (e.g., physicians services, physical therapy, or speech therapy) the provider agreement must be executed between the State Medicaid agency and the health professional. If the Head Start program bills for the services provided by health professionals under contract, there must also be an agreement for voluntary reassignment of payment between the provider and the Head Start program. Above all, Head Start programs should work with their State's Medicaid agency, as well as HCFA, to determine the most viable means of establishing Head Start/EPSDT health programs.

Although all the possible variations of these three basic service delivery roles cannot be cited in this guide, the examples provided in Chapter 4 may prove useful to Head Start staff seeking to increase participation in EPSDT. Staff should keep in mind that there is no one "best" or "correct" way for Head Start programs to relate to EPSDT.
 
 

Melissa is four year old girl who has been enrolled in the Head Start   program for about 30 days.  During this time, both through direct observation and   interview with her family, the Head Start staff have developed specific concerns   about Melissa's extremely aggressive and self-abusive behaviors, displayed both at   school and at home.  The Head Start mental health consultant conducts a screening   and determines that further mental health evaluation is necessary.  The Health   Coordinator arranges to meet with Melissa's parents to discuss the results of the    screening and to obtain permission for further assessment.           The Health Coordinator learns that Melissa is enrolled in the Medicaid   program, and has had dental services cover by EPSDT.  She would like to explore   if EPSDT can cover the costs of mental health assessment and treatment, if   necessary.  The Health Coordinator calls her contact at the local mental health   center and learns that the State Medicaid agency will first have to make a    determination about whether the assessment/treatment is medically necessary.  She   then speaks with the mental health consultant who conducted the screening.  The   consultant contacts the local Medicaid agency to begin the process of getting approval   for further medically necessary evaluation and treatment.           Within a few weeks, the Medicaid agency approves the provision of mental   health treatment.  With the permission from Melissa's mother, the health coordinator   follows up with the mental health provider and invites her to meet with Head Start   staff.  The mental health provider visits and recommends program modifications   designed to help Melissa develop more appropriate social interaction skills.  The   mental health provider agrees to visit the Head Start program bi-weekly to consult   with staff on Melissa's progress.  The initial visits and follow-up consultations are   paid for by Medicaid.