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.
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.
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.