The Centers for Medicare & Medicaid Services (CMS) released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and the Children’s Health Insurance Program (CHIP) coverage – nearly half of the children in this country – receive the full range of health care services they need.

Under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, eligible children and youth are entitled to a comprehensive array of prevention, diagnostic, and treatment services — including well-child visits, mental health services, dental, vision, and hearing services. These requirements are designed to ensure that children receive medically necessary health care services early, so that health problems are averted, or diagnosed and treated as early as possible. Because of the EPSDT requirements, Medicaid provides some of the most comprehensive health coverage in the country for children and youth.

The guidance issued today reinforces the EPSDT requirements and highlights strategies and best practices for states in implementing those requirements. This guidance, which was required by section 11004 of Title I of Division A of Bipartisan Safer Communities Act (BSCA) (P.L. 117–159), is the most comprehensive EPSDT guidance that CMS has released in a decade and is a critical step to ensuring the health of children.

“We need to make sure our children have what they need to stay well. Medicaid makes that possible,” said HHS Secretary Xavier Becerra. “This guidance to our states today will help millions of kids get the services that are crucial to their health and development, no matter where they live.”

“Our children are the future. They deserve the very best care possible and CMS is committed to ensuring that our nation’s children and youth get the right care, at the right time, in the right setting,” said CMS Administrator Chiquita Brooks-LaSure. “The implementation of the EPSDT requirements, in partnership with states, is vital to the tens of millions of children in the nation who are covered by Medicaid and CHIP. We’ll keep working until every child can get the care they need, when they need it.”

Today’s guidance is a critical step in CMS’ efforts to strengthen the Medicaid and CHIP programs across the country. The guidance clearly explains the statutory and regulatory EPSDT requirements, and suggests best practices across key areas, including increasing access to services through transportation and care coordination, expanding the children-focused workforce, improving care for children with specialized needs (including children in the child welfare system and children with disabilities), and expanding awareness among families of their children’s rights under the EPSDT requirements.

The EPSDT guidance also includes information to help address the needs of children with behavioral health conditions. Youth in the United States are experiencing a mental health crisis, research shows. The EPSDT guidance includes a series of strategies and best practices that states can use to meet children’s and youth’s behavioral health needs. For example, it suggests that states create a children’s behavioral health benefit package and support the management of children and youth with mild to moderate behavioral health needs in primary care settings. States must provide coverage for an array of medically necessary mental health and SUD services along the care continuum – including in children’s own homes, schools and communities — in order to meet their EPSDT obligation. This work builds on the HHS Roadmap to Behavioral Health Integration, which outlines the Department’s commitment to providing the full spectrum of integrated, equitable, evidence-based, culturally appropriate, and person-centered behavioral health care to the populations it serves, and builds on the President’s Unity Agenda to advance mental health.

The EPSDT requirements play a crucial role in the long road to achieving health equity by helping to provide access to essential care for children enrolled in Medicaid and CHIP. The guidance released today is one important step in the Biden-Harris Administration’s commitment to child health and access to affordable, quality health coverage for all, and is part of CMS’ broader strategy to ensure that children have the comprehensive and high-quality care they need. Beyond the importance of the EPSDT requirements, Medicaid more broadly is vital for ensuring the health of America’s youth. A new HHS report, Medicaid: The Health and Economic Benefits of Expanding Eligibility, by researchers in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) examines the impact of Medicaid throughout its six decades and highlights the importance of Medicaid coverage for low-income children. Studies show that access to Medicaid coverage is associated with a significant improvement in health and mortality that continues beyond childhood. In addition to improved health outcomes, children with Medicaid have improved educational and economic outcomes.

Congresswoman Carol Miller (R-WV)  introduced the Rural Communities Opioid Response Program (RCORP) Authorization Act with Representatives Terri Sewell (D-AL), Buddy Carter (R-GA), and Ann Kuster (D-NH). The RCORP Authorization Act will establish and expand prevention, treatment, and recovery services in rural areas for opioid users.

“Ensuring there are enough resources for those who are suffering from addiction is a top priority for me. As a representative for a rural district, I have seen firsthand how important it is for my constituents to have access to quality health care. The Rural Communities Opioid Response Program provides funding to rural communities that are in need of recovery facilities, and the program should be authorized to provide certainty for communities and providers. I thank my colleagues for partnering with me on this bipartisan issue to establish addiction prevention services in the most rural areas of the United States,” said Congresswoman Miller.

“The opioid epidemic doesn’t discriminate. As we see in Alabama, it affects people of every background and every zip code, urban and rural. By authorizing the Rural Communities Opioid Response Program, we can take critical steps toward expanding prevention, treatment, and recovery services for opioid users in rural communities. I’m grateful to be part of the bipartisan group of lawmakers working to make that happen,” said Congresswoman Sewell.

“The opioid epidemic is a nationwide crisis that especially impacts rural communities. As a pharmacist and representative for a rural district, I understand the importance of ensuring that all Americans have access to prevention, treatment, and recovery services. Formally authorizing the Rural Communities Opioid Response Program will save lives in districts like mine. I am proud to work in a bipartisan manner to ensure continued access to these vital health care resources,” said Congressman Carter.

“From health care workforce shortages to limited access to treatment and recovery services, rural communities in New Hampshire and across the country have been hit particularly hard by the addiction and overdose crisis. Ending the substance use disorder epidemic calls for an all-of-the-above government response, and the Rural Communities Opioid Response Program will help ensure that even our most rural communities have access to the resources and support they need to save lives,” said Congresswoman Kuster.

“Substance use, including opioid use, is exacerbated in rural America by a lack of access to care and treatment. The Rural Communities Opioid Response Program (RCORP) is a grant program aimed at alleviating this gap by establishing and expanding prevention, treatment, and recovery services. NRHA applauds the efforts of Representatives Miller, Sewell, Carter, and Kuster for their introduction of the RCORP Authorization Act and their continual leadership on rural issues,” said Alan Morgan, CEO of the National Rural Health Association.

“Rural communities have been uniquely tested by the opioid epidemic. Limited care options, transportation issues, and incomplete support systems along with barriers to reintegration into the workforce have created unique barriers on the road to recovery. The RCORP program has been critical in deploying needed resources to these communities while promoting unique collaborations that provide patient-centered care. As such, we enthusiastically support the continuation of this vital program,” said David Gozal, M.D., M.B.A., Ph.D. (Hon), Vice President for Health Affairs and Dean of the Joan C. Edwards School of Medicine at Marshall University.

​​”On behalf of the 50 State Offices of Rural Health, we are thrilled to see Reps. Carol Miller, Ann Kuster, and Buddy Carter introduce the RCORP Authorization Bill of 2024.  The RCORP grant program has been a lifeline for Rural population in West Virginia, New Hampshire, Georgia and all 50 states.  If passed into law this bill solidifies the standing of the program in the eyes of Congress – we look forward to working with our rural champions to ensure Congress passes this bipartisan bill into law,” said Tammy Norville, CEO of the National Organization of State Offices of Rural Health.

The Centers for Medicare and Medicaid Services is planning oversight of third-party healthcare vendors in the wake of the Change Healthcare cyberattack, said Jonathan Blum, the agency’s principal deputy administrator. Blum, who also serves as chief operating officer for CMS, said that the agency is working to determine what levers it can pull to ensure severe disruptions in care like those linked to the cyberattack on the UnitedHealth Group subsidiary aren’t repeated. CMS declined to provide any details of its oversight strategy, but said it is collaborating with other partners across the Health and Human Services Department to “promote high-impact cybersecurity practices and enhance accountability for healthcare organizations and their vendors.”

This week, the National Association of Community Health Workers introduced the CHWConnector tool where Community Health Workers and networks can share information, insights, and resources across social media platforms including Apple App Store, Google Plan and the Web. Stakeholders and partners created this tool to connect CHWs, on a state and local level to receive critical alerts related to public health emergencies and focus on policy and advocacy opportunities. The Connector is available in Spanish and has a toolkit. To join, go to www.CHWConnector.org

During the Public Health Emergency (PHE), Medicaid increased by almost 1 million enrollees in Pennsylvania. With the end of the Medicaid Continuous Coverage Requirement on April 1, 2023, enrollment in Medicaid began to steadily decline due to the disenrollment of those who were maintained due to the PHE and then deemed ineligible. In June, enrollment began to increase.  As of August 3, 2024,384 enrollees are accessing Medicaid with 22% of total enrollees from Philadelphia County, 8% from Allegheny, 4% from Delaware and Montgomery and 3% from Berks County. Of these numbers 58% are adults and 42% are children. This represents a 0.1% change over July 2024. Of note, CHIP Enrollment has increased as well to 195,320.

Devon Trolley, Executive Director of Pennie , Pennsylvania’s official health insurance marketplace – and Chairman of the Pennie Board, Michael Humphreys, issued a letter to Pennsylvania’s representatives in Congress strongly urging them to act now to extend the enhanced premium tax credits that dramatically reduce the cost of health coverage through Pennie for hundreds of thousands of Pennsylvanians. Click here to learn more.

Earlier this year, the Association of Clinicians for the Underserved (ACU) launched the National Center for Workforce Development & Training. To help ensure that the ACU National Center remains at the forefront of workforce transformation, they are now inviting representatives from health centers, primary care associations, external partners, and clinical and non-clinical professionals to serve on a new Advisory Council to provide critical guidance to shape ongoing initiatives. Sharing their expertise on workforce issues and fostering collaboration across healthcare sectors, the Council will ensure that ACU’s National Center drives impactful change to champion equitable solutions and support the development of a resilient, skilled, and diverse healthcare workforce to enhance care for medically underserved communities nationwide. Learn more about expectations and complete a brief form to be considered.

The Pennsylvania Area Health Education Center (AHEC) is offering an opportunity for high school students to learn about a variety of healthcare careers through their SEARCH Academy. This is a free program comprised of three virtual sessions on Wednesday evenings starting in Oct. and students can attend one, two, or all three sessions. Visit AHEC’s website for more information and to access the application. This is a great program to promote to any high school students you know and your local community to strengthen the workforce pipeline for the future.

The University of Pittsburgh invites Community Health Centers to become clinical sites for their second cohort of dental assistant trainees starting Jan. 27, 2025. Upon completion of the clinical training period, trainees in this program will have the skills and knowledge to become successful dental assistants who you may hire to grow their careers in your office. Visit their website for more information and complete the Clinical Site Form to be connected with a trainee. Reach out to the Dental Assisting Program Office with any questions or request a copy of the clinical site informational packet from Caitlin Wilkinson, Co-Director of the Pennsylvania Primary Care Career Center.

The Centers for Medicare & Medicaid Services issued a revised Medicare Learning Network (MLN) chronic care management services booklet. Changes include new codes describing chronic pain management and treatment and information about principal illness navigation services and community health integration services.