Issue Brief: Medicaid’s Children’s Benefit is ‘Gold Standard’ Compared to Commercial and Federal Health Plans - Families USA Skip to Main Content
11.20.2018 / Press Release

Issue Brief: Medicaid’s Children’s Benefit is ‘Gold Standard’ Compared to Commercial and Federal Health Plans

New research published today by Families USA reveals Medicaid’s child health component—the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit—is better than some of the most comprehensive employee health care insurance plans nationwide. The analysis is the first of its kind to compare Medicaid’s children’s benefit to seven other commercial plans from California and Florida, and also the Federal Employee Health Benefit Plan.

As this issue brief explains, “EPSDT is better than commercial plans because it is designed to meet the needs of children, rather than adults,” said Frederick Isasi, executive director of Families USA. “Instead of threats to restrict EPSDT through legislation or waivers, policymakers should focus on protecting the benefit and improving coverage. As CMS is undertaking unprecedented steps to remake the Medicaid program through administrative actions, this is an important time to protect these essential benefits for children. Some states have asked CMS to waive federally required portions of EPSDT coverage. Going down that path would be a big step backwards for children.

Medicaid insures more than 40 percent of all children under age 21 in the U.S., more than any other single insurance program. The EPSDT benefit addresses health inequities, ensures access to early intervention services, and provides key supports for children with significant medical needs.

Here are a few reasons why EPSDT stands out from commercial and Federal health plans; they are discussed in more detail in the brief: 

  • EPSDT services are provided as medically necessary for a child’s condition, with the goal of healthy development and treating or ameliorating illness.
  • Benefits start with a medical evaluation of the needs of the child and require follow-up treatment for any health conditions identified during regular screenings.
  • Key health care supports for at-risk children and youth with significant medical needs.
  • Provides greater financial protection for families.
  • Is the largest health care service for children and something every parent can count on no matter where they reside in the U.S.

In contrast, the large, commercial health insurance plans Families USA examined provide standard benefits based on the health needs of adults, not the pediatric services necessary to identify and address health conditions early, when treatment can have the greatest impact on a child’s health and development.

This brief is the third in a series of reports Families USA has produced in 2018 focused on Medicaid and children’s health, they include: Health Coverage Matters for Children: The Role of Medicaid in the Healthy Development of America’s Children and How Medicaid Protects Children with Special Health Care Needs.