EPSDT
A Guide for Head Start Programs

TABLE OF CONTENTS



Message from Head Start Bureau and the Medicaid Bureau

INTRODUCTION
Purpose of the Guide
Head Start and Medicaid Eligible Children
The Benefits of Head Start/EPSDT Linkages

CHAPTER 1
EPSDT PROGRAM ELEMENTS
Overview
Eligibility: Who Can be Served?
State EPSDT Requirements: What Services are Covered?
EPSDT Providers: Who Provides Services?
Reimbursement under Medicaid
Key Medicaid Principles

CHAPTER 2
EPSDT PROGRAM ACTIVITIES
Outreach/Informing
Eligibility Determination
Participation
Scheduling an Appointment and Transportation
Screening
Assessment of Results
Diagnosis
Treatment
Continuing Care
Periodic Renotification
Medicaid Managed Care

CHAPTER 3
HEAD START'S ROLE IN EPSDT
Introduction
Outreach
Case Management
Service Delivery

CHAPTER 4
EXAMPLES OF PROGRAM LINKAGES
Introduction
Examples of Linkages
Austin, Texas (29); Maine (31); Minneapolis, Minnesota (32);
Portsmouth, Ohio (34); Russellville, Arkansas (36)
Comparison of linkages

APPENDICES
APPENDIX A - Regional Contacts
APPENDIX B - State Contacts


A MESSAGE FROM THE HEAD START BUREAU AND THE MEDICAID BUREAU

Head Start and Medicaid have a long history of working together to ensure that the health care needs of low income children and families are being met. Today, in this time of limited resources and expanding needs, it is more important than ever that local, State, and Federal programs join forces in order to better serve their target populations.

This guide presents an overview of Medicaid's health program for children: the Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) program. Its purpose is to provide general information about ways Head Start programs can access preventive and treatment services for their Medicaid-eligible children.

The guide does not have all the answers. However, it is intended to be used as a starting point, for local, State and Regional programs as they develop or expand strategies for conducting ESPDT outreach and providing health services. Please do not hesitate to get in touch with the contact people who are listed in the text and its attachments. They can help you navigate the system by providing you with information on your State's program policy. Additionally, they may offer information on creative effective practices which can be useful.

We hope this guide will contribute to a fruitful dialogue in the interests of improving the health and well-being of children and families who need assistance the most.

INTRODUCTION

The purposes of the Medicaid program and the Head Start program are complementary to a high degree as both programs attempt to serve the health and developmental needs of young children. To the extent that some Head Start enrollees are also eligible for the Medicaid program, Medicaid can be used as an important resource for meeting the health care needs of certain Head Start children.

Consequently, the Health Care Financing Administration (HCFA) is committed to assisting Head Start in ensuring that the learning and developmental potential of Medicaid-eligible children is not threatened by poor health. Children receiving necessary health services are better prepared to succeed in Head Start, and in life. Since Head Start was established in 1965, it has recognized the importance of good health for a child's total development.

Head Start plays an important role in identifying children's health problems and improving access to a wide range of health care services. Head Start accesses many resources to finance health care and social services, including Medicaid. This guide was- written to assist Head Start programs in developing linkages with Medicaid, particularly the Early and Periodic, Screening, Diagnostic and Treatment (EPSDT) program.

Linking with EPSDT is beneficial to Head Start programs and to families because it provides for comprehensive health care, including preventive services, for Medicaid-eligible children up to age 21. Through EPSDT, Medicaid-eligible children receive health screenings, as well as medically necessary diagnostic and treatment services, for conditions identified through the screenings. The Head Start Health Performance Standards require that all children receive health screenings and any necessary treatment while they are enrolled in the program.

Purpose of the Guide

This guide is written primarily for Head Start Programs that are interested in increasing access to preventive and treatment services for their Medicaid-eligible children. The purpose of the guide is to encourage and assist Head Start, local education agencies, State and local health agencies, and other health and social service entities in becoming actively involved in their State EPSDT programs by using the Head Start setting as one resource in a total system of health care. Parents, providers of child care, community groups, and others may also find this guide helpful. In addition, Regional HCFA, Public Health Service, and State Head Start Associations may use this guide to provide assistance to Medicaid agencies and Head Start programs interested in developing effective models for providing EPSDT outreach, case management, and service delivery.

The purposes of this guide are to:

The examples of linkages between the Head Start and Medicaid programs in Chapter 4 should provide Head Start programs with a sense of the different arrangements that are possible.  In addition, each example includes a contact person who is available to answer questions and provide further information.

This guide does not provide all of the answers.  It was jointly developed by the Medicaid and the Head Start Bureaus in an effort to promote the development of the local Head Start-Medicaid linkages.  However, Head Start and Medicaid programs will find it to their advantage to establish partnerships with other community child health programs as well, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Title V, and Part H and Part B of the Individuals with Disabilities Education Act (IDEA).  The HCFA and ACF encourage the development of these partnerships.  Each State and local area has its own unique health and Head Start delivery system which needs to be considered when developing or enhancing a collaborative program.

At the end of the guide are appendices providing additional resources which may be helpful in developing and well coordinated, effective Head Start health care and EPSDT program.

Head Start and Medicaid Eligible Children

In 1989, an average of 39 percent of eligible children not enrolled in a managed care or case management program received EPSDT initial and periodic screening services.  To increase EPSDT participation, Congress mandated that the Secretary of the Department of Health and Human Services (DHHS) establish EPSDT participation goals.  The goals require that, by 1995, all States screen 80 percent of eligible children.  Many of the children served by Head Start are Medicaid-eligible. In 1993, 68 percent of Head Start children were enrolled in Medicaid. Improved linkages between Medicaid agencies and Head Start programs will help States meet their Congressionally mandated goals.

The Benefits of Head Start/EPSDT Linkages

Providers, including Head Start programs, may be reimbursed for preventive, treatment and other services provided to Medicaid-eligible children. Preventive health services are especially important for young children, since illnesses and disabilities not treated in childhood can easily become life-long health problems. The development of relationships with Medicaid providers offers an opportunity for Head Start to help link families to a network of health services, as required by the Head Start Performance Standards. These relationships can also improve the quality and scope of Head Start's health and disabilities functions. Medicaid also serves as a resource to Head Start in providing health care to certain children with disabilities. Through EPSDT screening and diagnostic services, Medicaid-eligible children with disabilities can be identified and provided necessary treatment. EPSDT may cover case management services, which can be particularly important for children with disabilities who have complex health, education, and social service needs. Head Start staff, working in Social Services, Parent Involvement, Health, Mental Health, and Disabilities components, often perform the case- management duties. Head Start/Medicaid linkages can also reduce duplication of services.