This issue brief provides a comprehensive look at the EPSDT benefit, including a plan-to-plan comparison with large scale health plans in two states and the Federal Employee Health Benefit Program (FEHBP). That comparison shows that Medicaid’s EPSDT benefit consistently offers more comprehensive coverage for children and greater financial protections for families. It is the gold standard in children’s health coverage.
Health Coverage Matters for Children: The Role of Medicaid in the Healthy Development of America's Children
Access to health care is crucial to children’s health and development. When children have health insurance, they are more likely to get the health care they need. For more than 40 percent of children in the U.S.—approximately 37 million children—Medicaid is the health insurance they rely on. Another 8.9 million children are enrolled in the Children’s Health Insurance Program (CHIP), Medicaid’s sister program. The success of Medicaid and CHIP is largely responsible for the fact that 95 percent of children under 18 have some form of health coverage.
Community Health Workers in Delivery and Payment Transformation: How New Delivery and Payment Models Can Incentivize and Support the Use of CHWs
The current attention on implementing delivery and payment reforms to improve the quality of care and health outcomes while reducing costs creates an important opportunity for greater integration of CHWs into the health care system and for providing more sustainable financing for CHWs. In this brief, we detail how health system transformation initiatives in Vermont and Oregon align with the value that CHWs provide and how these initiatives can incentivize CHW integration.
This brief highlights the value of integrating CHWs into maternal and child health care delivery to effectively address a range of health care concerns and conditions for children and families, offering examples of specific initiatives that are promising or have demonstrated impact in improving health care and health outcomes for children of color.
Lowering the price of prescription drugs remains one of the top health care priorities for consumers.1 But pharmaceutical manufacturers continue to increase prices on lifesaving medications.2 A recent proposal from the Trump Administration seeks to control prescription drug costs in Medicaid by giving states the authority to eliminate people’s access to needed and even lifesaving drugs. This approach fails to address the underlying issue of pharmaceutical manufacturers setting such high prices at the national level.
States have great latitude to determine the scope of dental benefits that they will cover for adults through their Medicaid programs. While some states cover comprehensive benefits, others cover emergency dental care only or none at all. This variation in coverage matters. Without adequate dental coverage, people face major barriers to getting care they need to stay healthy. To better understand the consequences of insufficient dental coverage, Families USA conducted a survey of states that cover emergency-only dental services.
Medicaid managed care contracting is a promising pathway for securing more sustainable funding for community health workers (CHWs). This issue brief provides examples of contract language that can be used to incentivize or require Medicaid managed care organizations to utilize and fund CHWs and considerations for advocates looking to improve support for CHWs through this pathway.
Half of U.S. children with special health care needs, nearly 7 million children, rely on Medicaid/Children’s Health Insurance Program (CHIP) for health insurance to cover some or all of their medical care. Medicaid and CHIP cover 48 percent of children with special health care needs. CHIP, which covers low- to moderate-income children above the Medicaid income limit, is administered by states sometimes as a separate program, but often through state Medicaid programs. This issue brief explores why Medicaid plays a unique role in serving children with special health care needs.