The Promise and Failures of Children's Medicaid and the Role of Medical-Legal Partnerships as Monitors and Advocates

For decades we have known that access to health care and early and preventive diagnosis and treatment can dramatically alter the course of a child’s life. Because of this knowledge, immediately after Congress enacted Medicaid, it created the Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, program for children. EPSDT requires broad holistic and preventive care to correct or ameliorate health defects identified in Medicaid-eligible children. This coverage currently extends to 2 out of 5 children and 48 percent of children with special health care needs. Because of the broad parameters of coverage mandated by EPSDT, eligible children should receive any and all necessary medical care indicated by their health care providers. Tragically, for children like Savannah, a Medicaid-eligible girl with complex medical needs in Michigan who was denied access to the physical therapy, occupational therapy, and speech therapy critical to maintaining the ability to walk, feed herself, and function with some independence, failures in EPSDT implementation has resulted in unmet needs. As states have adopted state plan guidelines and transitioned to privatized Medicaid through contracts with Medicaid managed care organizations in an effort to cut growing costs, coverage gaps for vulnerable children have intensified, leaving parents and providers feeling the desperation of not being able to give their patients and children the care they need.Medical-legal partnerships - interdisciplinary collaborations between health care providers and lawyers - are well suited to monitor EPSDT compliance, engage medical providers in informed patient advocacy, facilitate exchange of information regarding failures in coverage, and hold Medicaid programs accountable to low-income children. This article will review the history of the public health insurance system, outline the current legal mandates and landscape of EPSDT, and discuss the role that medical-legal partnerships can play in ensuring that EPSDT fulfills its purpose.