The Health Care Authority (HCA) administers the Medicaid program, which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria. Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package, including prescription drug coverage, to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women. The majority of Apple Health enrollees receive their coverage through managed care organizations (MCOs). The remainder receive their care through fee-for-service (FFS).
Early Periodic Screening, Diagnosis, and Treatment (EPSDT), also known as well-child checkups, are regular, complete health exams for children and youth intended to help identify and treat health issues early. EPSDT is a free health program for individuals, under the age of 21, enrolled in Apple Health coverage. The American Academy of Pediatrics' Bright Future Guidelines recommended schedule provides a total of 31 EPSDT visits from birth through age 20, whereas Apple Health only covers 22 EPSDT visits for the FFS enrollees. MCOs may exceed the FFS benefit and currently all five of the MCOs align their EPSDT benefit schedule with the Bright Future Guidelines.
Beginning July 1, 2022, HCA must ensure their schedule for covering Apple Health's EPSDT benefit aligns with the Bright Future Guidelines or a comparable standard.
The committee recommended a different version of the bill than what was heard. PRO: Children on medicaid, regardless if their coverage is managed care or fee-for-service, should all receive the same EPSDT benefit schedule. Early screening can lead to better detection which can provide better health outcomes. The current Apple Health EPSDT benefit schedule is inadequate. The nine additional well-child visits this bill provides are critical. An additional visit from 0-6 weeks, so there are two total visits during this time frame, is necessary for monitoring a baby's weight gain and addressing any breastfeeding challenges. Adding a check-up when a child is two and a half years old is crucial for catching developmental delays and referring the child to for necessary therapies and interventions. The seven additional well-child visits this bill would cover for ages three and up will provide annual well-visits that are important for addressing obesity, mental health, and vision issues many children face. We request moving up the start date to July 1, 2022.
CON: We are concerned about the mental health components of this bill and how it results in children and adolescents being unnecessarily screened, diagnosed and treated for mental health issues. Help support the mental health component. We request changes to the informed consent process and that all youth have the ability to opt-out of invasive and mental health treatment.