State to Counties: EPSDT Is Still An Entitlement

California has compensated several counties retroactively for expenditures on Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), and is assuring counties that obligations under the federally mandated program have not been dropped in their laps.

“Realignment has not diminished this entitlement to services,” said Carol Sloan, an information officer at the California Department of Health Care Services (DHCS), in an e-mail to The Chronicle. “These entitlement programs…will continue to be a priority in the allocation of growth funds.”

3462897583_7bbd1fd251_z This decision comes after criticism of the state’s decision to place EPSDT services under the 2011 California Realignment, which set the entitlement into a block grant of sorts, as was recently reported by The Chronicle of Social Change.

The idea behind EPSDT is to identify and deal with potential health issues – which include mental health, preventative health, dental health, and other special health services – at an early age as to avoid possible lifelong impact. States are obligated by federal law to provide EPSDT to all Medicaid-eligible children.

Major concerns about EPSDT under realignment came from the necessity of counties to pay for whatever they “overspent” on these services, without any idea of whether or not they’d be reimbursed.

DHCS announced late last week that it was distributing $8.7 million to eight counties that overspent their allocations for EPSDT and another federally mandated Medicaid program last fiscal year: Del Norte ($42,933), Glenn ($50,916), Imperial ($313,012), Inyo ($18,119), Los Angeles ($6,119,948), Modoc ($63,742), Mono ($21,028) and Santa Clara ($2,064,176).

The funds come from a $27.9 million pot of money in a growth fund fueled by 2011 revenue that was set aside specifically for behavioral health services.

Alameda and Los Angeles officials told The Chronicle they were able to pay for EPSDT costs above their allocation while they asked for compensation from the state. For smaller counties, that wasn’t necessarily the case. Los Angeles was remunerated about $6 million, and Alameda ended up not overspending their allocation under the first year of realignment in 2011.

Alex Briscoe, director of the Health Care Services Agency in Alameda, questioned the legality of a process where counties were allocated funds for EPSDT and expected to pay any costs over the allocation.

Sloan told The Chronicle that the state only expects counties to contribute five percent of EPSDT funds, which has been the arrangement since 2003, and that the allocations for 2014-2015 would reflect that.

In Los Angeles, Marvin Southard, director at the Department of Mental Health, noted the amount they were being reimbursed was satisfactory for that year.

“We feel we’ve been made whole for that fiscal year, and we hope and expect that as EPSDT grows, we will be treated similarly,” Southard said.

The 2013-2014 percent allocations for total EPSDT services for counties can be seen here.

Victor Valle is a reporter at the Chronicle of Social Change.

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