Transportation is essential for children and youth with special health care needs (CYSHCN) to regularly access health care and support chronic health conditions that require ongoing treatment. However, CYSHCN are significantly more likely to delay care due to transportation barriers than children and youth without a special health care need. State Medicaid agencies are required to administer the non-emergency medical transportation (NEMT) benefit, which provides coverage for rides to and from medical appointments for all Medicaid beneficiaries. States determine when a ride is necessary (e.g., a beneficiary has a mental or physical disability). Knowledge of the NEMT benefit can assist state health officials, including state Title V program staff, in supporting access to care for CYSHCN enrolled in Medicaid.

State Medicaid programs are required to provide Medicaid enrollees under age 21 with comprehensive and preventive health care services through the Early Screening and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Federal law requires states to cover “medically necessary services” under the EPSDT benefit “whether or not such services are covered under the State plan.”  The federal statute does not define “medical necessity” but instead describes a broad standard for coverage. States can, therefore, establish their own parameters for medical necessity decisions so long as those parameters are not more restrictive than the federal statute. In March 2021, with support from the Catalyst Center, The National Academy for State Health Policy (NASHP) conducted a 50-state scan of medical necessity definitions used by state Medicaid programs for their EPSDT benefit, updating a previous scan conducted in 2013. This resource presents definitions of medical necessity from all 50 states and the District of Columbia.