Why We Care About Medicaid “EPSDT” Benefits
and So Should You

While threats to the Affordable Care Act (ACA) may seem the most imminent in our current political landscape, Medicaid is also under attack. Congress and the new administration are discussing deep cuts and changes to the Medicaid program, through Medicaid block grants or per capita program caps. The new administration recently said they will be proposing block grants. 

Medicaid block grants result in funding cuts and fewer people receiving coverage. Utah has long been recognized as a leader in health care innovation, but our ability to innovate will be severely impaired if we experience cuts to our foundational health care safety-net system through block grants. Medicaid is the cornerstone to children’s health coverage in Utah.

In a recent letter to Congress on January 13th, the Governor and state officials weighed in on a number of health reform proposals, including Medicaid. We saw many areas for concern in our state leaders’ letter; one brief recommendation in particular jumped out at us, because it would have significant and long-lasting consequences for children and families:

“Reevaluate the EPDST (Early Period Screening, Diagnosis and Treatment) benefit for children. EPDST requires states to provide comprehensive and preventative health services for Medicaid beneficiaries under the age of 21 with few limitations.
Consider limiting benefits to what is available in the private market. Currently, children on Medicaid have more access to services and benefits than children who are covered under good commercial plans.”

So, what is EPSDT?

Early, Periodic Screenings, Diagnosis & Treatment

The EPSDT benefit, known in Utah as “CHEC” or Children’s Health Evaluation and Care, is one of the hallmarks of the Medicaid program. The Medicaid Act currently requires states to provide children with a comprehensive scope of services. For decades, EPSDT has allowed providers to catch potential health problems early, when they are easiest to treat and children stand the best chance of developing to their fullest potential. Covered EPSDT services include basic preventative care, such as dental and vision services, plus services needed to address acute, long-term, and disabling conditions, such as physical, speech and behavioral health therapies and in-home nursing. The EPSDT benefit is considered the gold standard for children’s pediatric benefits. It helps doctors determine the best level of care for their patient.

EPSDT has helped millions of children, especially children with special health care needs, receive the level of the care they need. In fact, many families in the private insurance market will turn to Medicaid coverage for their children with special health care needs-- because they cannot afford such comprehensive benefits in their “good” commercial plan.

We Need to Protect EPSDT

Medicaid is the cornerstone for children’s health coverage in our state, and serves over 20% of our most vulnerable families. If we roll-back the EPSDT benefit, we will see a surge of parents no longer able to afford care, particularly for children with special health care needs.
EPSDT protects families; it assures families that they can receive a minimum level of coverage and have access to services that meet prevailing standards of care. For many higher-income families, Medicaid may seem unconnected to their day-to-day lives. But one of the core tenets of our health care safety-net is that it is there for families when they need it.

There are many improvements needed to our Medicaid program. But the EPSDT benefit package is not one of them. So why fix what isn’t broken? Instead, for example, Medicaid mental and behavioral health services should be better integrated and aligned with physical health benefits.
Instead of trying to raise health care standards for all kids, our state and federal leaders are instead looking to dilute standards. It is perverse logic to limit progress and roll-back gains, in order to achieve equality. Instead we should advance the progress made so all children can achieve affordable, comprehensive coverage.

We urge our state and federal leaders:

Do not limit benefits for children and weaken our existing standards.
Build on the progress we have made.
Strengthen coverage and care for all Utah children.

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

Changes to Medicaid’s financing structure through a block grant or per capita cap would create large shortfalls in state funding. These would inevitably lead to limits placed on the program, such as a reduction in benefits or fewer children covered. The impact of these cuts would be even greater when utilization or enrollment goes up. For example, Utah would not be able to keep up with Medicaid demand during a recession, when many more children become newly eligible for and enroll in Medicaid. During the last recession, Medicaid added 30,000 enrollees in one year, a growth rate significantly higher than previous years. Under a block grant or per capita cap structure, the state would not be able to meet this sudden demand.

The charts below illustrate the Utah budget impact of the most recent House of Representatives block granting or per capita cap scenario if it had gone into effect a decade ago. The scenario is based on House Speaker Ryan’s federal budget proposal for FY2017. Under the proposal, Utah could expect to see a 25% cut to its federal Medicaid funding by the end of the first decade, because the proposal limited increases in federal Medicaid funding to the general consumer inflation rate rather than the medical cost inflation rate, which is higher (even for Medicaid, which has a lower inflation rate than private insurance). Thus, the scenarios below show federal Medicaid funding to Utah increasing annually by about 2% rather than the actual average increase of over 5%.

Since the Ryan proposal did not specify a state match or Maintenance of Effort (MOE) requirement, we present a worst-case scenario where Utah’s state Medicaid contribution remains flat at the FY2007 level and a best-case scenario where Utah’s state Medicaid contribution increases by 60% over the last decade (as it actually did in nominal terms, not adjusted for inflation).*

*Based on information available from Utah Medicaid Annual Reports. For additional information on Speaker Ryan’s proposals see the Congressional Budget Office report, “The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan,” March 2012, .

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

Oral Health Care for Children and Families

Tooth decay is the top preventable disease for kids. When kids experience poor oral health, their school attendance and grades are likely to suffer. Kids experiencing dental pain cannot concentrate in school and fully participate in activities. What’s more, oral health decay can lead to other serious medical problems. An estimated 65% of Utah children have experienced a dental cavity by the time they are 9-years-old.

The best way to treat cavities is through prevention: we can prevent oral health problems before they occur. But many families have trouble accessing affordable dental care for their kids. Working parents may not be able to get the time off for a routine visit. Low-income children, children of color and children in rural areas have an even harder time accessing a dentist in their communities. According to a recent Department of Health report, Hispanic children were five times more likely to report having unmet dental health needs compared to White children. 

School-based prevention or sealant programs are one of the best ways to ensure all kids can receive affordable, preventative oral health care.

We need to help more children access school-based sealant programs and affordable care. Voices for Utah Children supports policies that expand dental care access for all children including:

• Changes to the Utah Medicaid dental program to better meet the needs of low-income families and expand school-based care, including reimbursing for patient assessment in a public health settings (Medicaid code D0191).
• Expanding Medicaid and CHIP oral health quality performance measures, monitoring and evaluation to improve kids’ utilization of preventive care visits.
• Expanding dental health benefits for children in the marketplace, including a more robust pediatric dental benefit package and embedding children’s dental health benefits into all plans.
• A comprehensive state plan to address oral health access disparities experienced by low-income children, children of color, and children in rural areas across the state.

Our children should not be falling behind due to cavities or oral health pain. Together we can strengthen our pediatric oral health system so all kids can succeed.

Image Credit: © Oksun70 | Dreamstime.com - Kid Girl Brushing Teeth In Bathroom Photo

Image Credit: American Dental Association

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

New Utah-specific report on ACA repeal details impact to Utah families

Salt Lake City—The number of uninsured Utah children would more than double if Congress repeals the Affordable Care Act (ACA) without a comprehensive replacement plan, according to new data released by the Urban Institute. The new data offer more detail than we’ve ever seen before about how repeal without a replacement will affect Utah children and families. As Congress and the new administration begin the process of repealing the ACA, they have yet to negotiate an agreement on a replacement and may delay doing so indefinitely.

Repealing the ACA without a replacement in place will leave even more Utah children uninsured than before the ACA came into being. While most attention has been directed toward the fact that ACA repeal could end the ACA health insurance marketplace—in itself devastating for Utah families because Utah has one of the highest marketplace enrollment rates in the nation—the ACA repeal will also affect CHIP and Medicaid, tearing away at key features of Utah’s safety net that existed long before the ACA.

All Utah families stand to lose a number of health insurance protections, not only families enrolled in the marketplace. In a letter to Congress dated January 13th, Governor Herbert and state officials expressed interest in rolling back ACA protections from insurance discrimination based on gender. In the same letter, they also supported a return to exclusions for those with pre-existing conditions. The roll-back of these ACA protections would lead to an increased medical burden for many Utah families.

The report by the Urban Institute estimated that by 2019, Utahns would see the following consequences of ACA repeal:

• 273,000 more Utahns would become uninsured, raising Utah’s total uninsured rate from 12% to 21%.
• 73,000 Utah children would become newly uninsured, resulting in 141,000 children without insurance. Of the Utah children who stand to lose insurance, 88% have at least one full-time working parent in the home.
• 89,000 additional Utah parents would become uninsured, putting increased economic stress on the entire family.

“Thanks to the ACA, CHIP and Medicaid, more Utah children are insured than ever before,” said Jessie Mandle, Senior Health Policy Analyst at Voices for Utah Children. “We need a plan to build on these gains, instead of going backward.”

Read the Utah fact sheet here:
Partial Repeal of the ACA through Reconciliation: Coverage Implications for Utah Residents

The new Utah factsheet is based on research compiled by the Urban Institute in December, which was modeled on a Congressional repeal bill from 2016 similar to present Congressional proposals.
Partial Repeal of the ACA through Reconciliation: Coverage Implications for Parents and Children

Image Credit: Monkey Business Images | Dreamstime.com - Mother Taking Temperature Of Sick Daughter

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

The 2018 Utah Legislative Session will take place from January 22 to March 8, with 45 days chock full of long committee meetings, urgent Action Alerts, conversations between community members and legislators, demonstrations on the steps of the State Capitol Building and much more! 

We'll be following a lot of different bills during the 2018 session, not all of which will be made public before the session officially begins. Some bills are introduced with language that we support, and then that language changes over the course of the legislative process. Occasionally, the changes are subtantial enough to warrant a change in our position. We will do our best to keep this list of bills - as well as our positions - updated for your information, but it can be tricky when things are so busy for our staff during this crazy time of year. 

We are working on several bills that will be priorities for us in 2018. You can learn more about these priority legislative proposals by clicking on the topic links below. 

Tax and Budget Issues

Creating a State Earned Income Tax Credit (EITC)

Restoring Investment in Children

Health Issues

12-Month Continuous Eligibility for Utah Kids with Medicaid

Maternal Health

Oral Health

Health Coverage

Early Childhood Care & Education Issues

High Quality Child Care

Governance and Coordination of Early Childcare Services

Juvenile Justice Issues

Implementing Juvenile Justice Reform

Bills

News Contact Lawmakers  Sign Up for E-AlertsFollow @utchildren

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Medicaid, CHIP (the Children’s Health Insurance Program) and the Affordable Care Act (ACA) form the foundation of children’s health coverage. These programs are deeply connected to one another and our overall state safety net system. Federal and state lawmakers are proposing and enacting proposals that undermine ACA, CHIP and Medicaid. A repeal, cut or restructure of one program affects the others, and puts the care of Utah children and families at risk.

Thanks to the ACA, Medicaid and CHIP, we have seen the rate of uninsured Utah children drop from 11% in 2011 to a historic low of 6% in 2016. We cannot afford to let child health coverage, adequacy, and affordability move backwards. We must ensure that we sustain and build on our unprecedented success in covering children.

Medicaid is the cornerstone for children’s health coverage. Our state leaders must support the continued stability and affordability of the Medicaid program. Medicaid is the safety net health care program for low-income children. Over 200,000 Utah children rely on Medicaid insurance coverage, and its pediatric benefits are considered the gold standard for child health, particularly for children and youth with special health care needs. Changes to Medicaid’s financing structure through a block grant or per capita cap would undermine the program’s integrity by creating gaps in state funding. They would likely lead to limits placed on the programs, such as a reduction in benefits or fewer kids covered. Proposals to promote state innovation need to strengthen our safety net for kids and families, not weaken it.

Block grants or per capita caps would undermine Medicaid program integrity. Changes to Medicaid’s financing structure through a block grant or per capita cap would create large shortfalls in state funding. Learn more about how block grants would harm Utah's budget.

Extend funding for CHIP for at least five years. A robust, long-term extension of CHIP funding for at least five years would help stabilize coverage for the 8.9 million U.S. children who rely on CHIP and provide certainty to Utah amid potentially significant changes to the broader coverage landscape. Learn more about CHIP.

Children must not lose any ground. Unraveling the ACA without a replacement plan attached threatens the health of children and families. There are 38,000 Utah children enrolled in ACA, or marketplace, coverage. At least 87% of Utahns enrolled in the exchange are receiving subsidies. The ACA provides protections for children and families, increases affordability and establishes evidence-based essential health benefits.

Extend Medicaid Coverage for Parents. Medicaid coverage for parents benefits the whole family. Yet thousands of Utah families are unable to receive Medicaid coverage, falling into the Medicaid ‘coverage gap.’ As a result, the family is at increased financial risk. Moreover, children are more likely to be uninsured. It is time to close the coverage for all parents and individuals. Learn more about citizen initiatives to close the coverage gap.

Working families depend on these vital health care programs. What is at stake if the ACA is repealed without a replacement, or changes are made to CHIP and Medicaid?

• The number of uninsured Utah children would more than double. By 2019, at least 141,000 children would be uninsured.
• The number of uninsured Utah parents would jump from 82,000 to 171,000. Research shows that children are better off when their parents have health insurance coverage.
• Families and individuals would lose protection from exclusions and discrimination. Approximately 1.2 million Utahns – including 411,000 children- no longer experience lifetime limits on coverage now that the ACA is in effect.

We are putting our children’s future at risk by failing to guarantee Utah children and families have stable health insurance coverage. All children and families need consistent, comprehensive and affordable care.

Medicaid Helps Utah Children Get the Health Care They Need to Succeed from Georgetown CCF on Vimeo.

Printer-friendly Version:

Preserve and Protect Health Coverage for Utah Children and Families

Additional Materials

Utah Children and the Terrible, Horrible, No Good, Very Bad Healthcare Repeal Bill

Utah Snapshot of Children's Coverage: How Medicaid, CHIP, and the ACA Cover ChildrenHow Medicaid, CHIP, and the ACA Cover Children

In Support of Medicaid Standards for Children

Block grants or per capita caps would undermine the Medicaid program.

Number of Uninsured Utah Kids and Parents Would More than Double if ACA Repealed

The ACA Gave a Needed Boost to Utah’s Latino Child Health Insurance Rate

Tell Senator Hatch Not to Repeal the ACA without Replacing It

Defending Health Care in 2017: What Is at Stake for Utah

273,000 Utah Residents Would Lose Coverage in 2019 Under ACA Repeal2019 Under ACA Repeal

What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

Fact Sheet: Per Capita Caps vs. Block Grants in Medicaid

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

For Printable Version Maternal Mental Health Support Flyer

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor. 

Repealing the Affordable Care Act (ACA) will cause 273,000 Utahns to lose their health insurance by 2019, new Urban Institute estimates show. Congress plans to move quickly in January to repeal much of the health reform law without enacting a replacement plan first. This would cause families in Utah to go without needed health care and expose them to financial risk. Nationally, most of the coverage loss would occur among families with at least one worker, doubling the number of uninsured and leaving a higher share of people uninsured than before the ACA.

Leaders in Congress are contemplating an unusual and risky maneuver to repeal the ACA without simultaneously passing a replacement plan. The repeal part would be easy because Congress would take advantage of special rules that apply to budget reconciliation bills. Congress could indefinately delay the far more difficult task of replacing the ACA with a new plan. 

If Congress succeeds in repealing the ACA without a replacement plan attached, they will throw the health care system into chaos. Nationwide, 4.3 million people would lose insurance right away, rising to 7.3 million by 2019.

The consequences of repealing the ACA without replacing it would be dire for Utah families.

The number of uninsured Utahns would nearly double, rising from 328,000 uninsured Utahns to about 601,000.

The uninsured rate among children would more than double. Almost 38,000 Utah children currently have coverage in the ACA health insurance marketplace. These children are at risk of becoming uninsured if the ACA is repealed. After implementation of the ACA, Utah and the nation as a whole saw significant improvements in child health insurance coverage rates. Repealing the ACA without replacing it would not only eliminate these gains, but result in an even higher uninsured rate for children nationwide than existed before the ACA came into effect. 

Utah would lose $4.8 billion in federal funding and pay more in uncompensated care costs. State and local governments and health care providers would have to bear this cost.

Moderate-income working families in Utah would lose substantial financial assistance that is now available to help them pay  for their insurance premiums. The vast majority—87%—of Utahns in the ACA marketplace receive subsidies. In 2016, Utahns who enrolled in marketplace coverage receive an average advance premium tax credit of $187, which covers 69% of the total monthly premium for comprehensive coverage. 

Become Involved

Contact Senator Hatch

Tell Senator Hatch to protect our healthcare for children and families. Tell him not to repeal the ACA without a replacement bill in place to keep children and families covered by health insurance. Call Senator Hatch at (202)224-5251 or email Senator Hatch using this form.

Share Your Story

Does your family benefit from the ACA, Medicaid or CHIP health coverage? We want to talk to you. Your story could make a difference as we explain to lawmakers how repealing the ACA without replacing it could affect their constituents. Contact us.

More Information

Let’s Keep Moving Forward: The ACA’s Impact on Children’s Health Coverage

New Study Shows How ACA Repeal Would Impact Utah

Center on Budget and Policy Priorities Fact Sheet: How Repeal of the ACA Would Affect Utahns

There Are 20,000 Fewer Uninsured Kids in Utah, Thanks to the Affordable Care Act

For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

How can you be involved?

Make a tax-deductible donation to Voices for Utah Children—or join our Network with a monthly donation of $20 or more.  Network membership includes complimentary admission to Network events with food, socializing, and opportunity to meet child advocacy experts. And don't forget to join our listserv to stay informed!

We look forward to the future of Voices for Utah Children and we hope you will be a part of our next 30 years.

Special thanks to American Express, our "Making a Difference All Year Long" sponsor.