Resources produced by our team include hundreds of papers, peer-reviewed articles, manuals, and other products on a range of topics related to health and social needs services and supports.

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State Definitions of Medical Necessity Under the Medicaid EPSDT Benefit

Authors NASHP

Date 2021

Project Catalyst Center

Keywords CYSHCN, Financing, Health Benefits, Medicaid/CHIP

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.

Improving Care Coordination for Children with Medical Complexity: Exploring Medicaid Health Home State Options

Authors Veronnica Thompson, Kate Honsberger

Date 2021

Project Catalyst Center

Keywords CYSHCN, Financing, Medicaid/CHIP

States are increasingly interested in care coordination as a strategy for improving systems of care for children with medical complexity (CMC) and their families. The Section 2703 Medicaid Health Home State Option and the new Advancing Care for Exceptional (ACE) Kids Act Health Home State Option present opportunities to enhance and expand care coordination for CMC in Medicaid. This new brief compares the two approaches and presents key considerations for states as they explore implementing health home options. Additionally, the brief presents New York as a case study in implementing the Section 2703 Medicaid Health Home State Option to provide care coordination for CMC. 

The Role of State Medicaid and Title V Program Definitions of Children and Youth with Special Health Care Needs in the Provision of Services and Supports

Authors Taylor Platt, Eddy Fernandez, Kate Honsberger, Karen VanLandeghem

Date 2020

Project Catalyst Center

Keywords CYSHCN, Financing, Health Equity, Medicaid/CHIP

This issue brief, written in partnership with the National Academy for State Health Policy (NASHP), describes how states define CYSHCN within Medicaid and Title V CYSHCN programs and explores the implications of these definitions. Federal and state program approaches to defining children and youth with special health care needs (CYSHCN) can impact how they determine eligibility for health care services and supports (e.g., care coordination), evaluate the impact of services, and measure outcomes.  The brief presents an analysis of data gathered through administrative and interview data from seven states (AZ, FL, NY, OH, OR, UT, and VA), and presents state considerations for establishing and implementing definitions of CYSHCN.

COVID-19: The Coronavirus Aid, Relief, and Economic Security (CARES) Act and Employment

Authors

Date 2020

Project Catalyst Center

Keywords Covid-19, CYSHCN

Part of the Catalyst Center COVID-19 Resource Series. 

The public health emergency resulting from the COVID-19 pandemic has real implications for state Title V programs as well as families raising children and youth with special health care needs (CYSHCN).

State programs like Medicaid/CHIP and Title V, which are integral to the system of services and supports for children and youth with special health care needs, must be ready to adapt and respond to the current challenges faced by children, families, providers, and other stakeholders.

These fact sheets help explain employment provisions for families in the CARES Act. Families raising CYSHCN are more at risk than ever for experiencing financial hardship due to job loss, loss of health insurance, and other factors. Understanding these policy changes can aid in reducing the risk of family financial hardship.

Download the full series, or individual fact sheets below. 

COVID-19: Flexibility for States: Medicaid and CHIP Programs

Authors

Date 2020

Project Catalyst Center

Keywords Covid-19, CYSHCN

Part of the Catalyst Center COVID-19 Resource Series. 

The public health emergency resulting from the COVID-19 pandemic has real implications for state Title V programs as well as families raising children and youth with special health care needs (CYSHCN).

State programs like Medicaid/CHIP and Title V, which are integral to the system of services and supports for children and youth with special health care needs, must be ready to adapt and respond to the current challenges faced by children, families, providers, and other stakeholders.

These fact sheets help explain Medicaid and CHIP program flexibilities to Title V program staff and allies. Understanding these policy changes can support activities related to care coordination, benefits and coverage counseling, and aid in reducing the risk of family financial hardship.

Download the full series, or individual fact sheets below.