New Toolkit to Strengthen Medicaid EPSDT Implementation

When 8-year-old Marcus had serious depression, his care team recommended a partial hospitalization program to improve his mental health symptoms and prevent full inpatient admission.

His children’s hospital documented the medical necessity and submitted the authorization request to the state Medicaid agency.

But the request was denied.

Without approval, the hospital couldn’t secure payment for his participation in the program, and Marcus’ symptoms intensified, necessitating the full inpatient admission his providers were hoping to avoid.

Medicaid is a critical tool for responding to the youth mental health crisis, but not all Medicaid-enrolled children who need behavioral health services receive them.

The fragmented system has caused barriers for children’s hospitals when it comes to identifying and authorizing mental health services under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

To address these challenges, the Children’s Hospital Association is developing a Medicaid EPSDT Toolkit. The resource will be available summer 2026 and will help children’s hospitals close the gaps in state Medicaid implementation so children can get the mental health care they need, when they need it.

“Most states don’t implement EPSDT effectively when it comes to mental health services,” said Heidi Baskfield, vice president of mental health and executive director of Speak Our Minds, an affiliate of CHA. “This toolkit will help hospitals and their partners identify the services they already provide or intend to provide and identify the gap in getting those services authorized and paid for.”

Understanding EPSDT

The EPSDT benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT requires states to provide all necessary services — preventive, dental, mental health, and specialty — to treat health conditions identified through screenings.

EPSDT is defined as:

• Early: Assessing and identifying problems early
• Periodic: Checking children’s health at regularly scheduled examinations
• Screening: Providing tests to detect potential conditions
• Diagnostic: Performing tests to follow up when a risk is identified
• Treatment: Control, correct, or reduce health problems found

Under this benefit, states must cover all screening services for children and any needed therapies, long-term care, home care, assistive technology, and nonemergency medical transportation. It provides comprehensive coverage to increase access to needed services.

Turning policy into practice

The EPSDT toolkit is being designed to help children’s hospitals navigate the complexities of the Medicaid benefit package. CHA, policy experts, and leaders in pediatric behavioral health care are developing it with a focus on infant and early childhood mental health.

Key features will help children’s hospitals engage state Medicaid agencies and lawmakers by utilizing:

• Templates and checklists: Standardized approaches to document authorizations and meet state and federal EPSDT requirements
• Data collection guidelines: Information on what data hospitals need to provide to ensure coverage, reduce denied claims, and identify coverage gaps
• Advocacy and engagement tools: Materials to support Medicaid agencies in implementing EPSDT and strategies for legislative action if agencies do not act

Bridging gaps in state implementation

One of the common challenges children’s hospitals face is how states implement EPSDT, leading to inconsistency in Medicaid approval and payment.

States are required to follow a schedule of recommended screenings to determine if a child is struggling with mental health conditions like anxiety, depression, or suicidal thoughts. These screenings help ensure timely access to early intervention services that address the early signs and symptoms of a child’s mental health care needs.

But state processes often create disparities in mental health care access, diagnoses, and treatment. Many state policies limit access to critical mental health services, including personal hospitalization programs and therapy.

By using the EPSDT toolkit, children’s hospitals will be able to identify and authorize services and use data guidance to help inform discussions with state agencies to promote stronger enforcement of the benefit.

“It gives children’s hospitals the ability to create a scenario where mental health services are core services, and we can create ongoing, sustained access,” Baskfield said. “You’re going to have more kids able to get the care they need, when they need it.”

Stepping toward ongoing access

No child in crisis should have to wait for care because of inconsistencies with EPSDT implementation.

The first EPSDT toolkit will be an important step forward in strengthening hospital advocacy and supporting ongoing access to mental health care for children.

With actionable tools and strategies, we can move closer to a future where every child on Medicaid receives timely, effective mental health services no matter the state they live in.

Learn more about how CHA has advocated for better mental health care for children.