Partnerships with State Medicaid and Children’s Health Insurance Program (CHIP)

Medicaid, the Children’s Health Insurance Program (CHIP) and Title V serve many low-income women and children, including children with special health care needs. Medicaid and CHIP provide free or low cost health insurance to eligible participants. Title V provides Federal block grant funds to States, where they support comprehensive services to women and children with limited access to health care services.

Title V complements Medicaid and CHIP by

providing gap-filling services to enrollees
assisting in the identification of potentially eligible beneficiaries and
creating an infrastructure in communities to ensure that the capacity exists to support the delivery of quality health care services for women and children.

Successful coordination of Title V with Medicaid/CHIP programs assists in maximizing Federal, State and local funds to meet the health care needs of low-income women and children.

Coordination between State Title V and Medicaid agencies is required by the following statutes and regulations:

Title XIX: requires State Medicaid programs to enter into cooperative agreements with State agencies receiving payments through Title V to the extent required by the Secretary. These agreements must include provisions for reimbursement of services provided to Medicaid beneficiaries, and “coordination of information and education on pediatric vaccinations and delivery of immunization services."
(§1902(a)(11)(B) of Social Security Act)
Medicaid Regulation: builds on the Title XIX of the Social Security Act Statute requiring arrangements between state Medicaid agencies and Title V agencies. The regulation lists specific requirements including, “early identification of individuals under 21, in need of medical or remedial services” and “payment or reimbursement.”
(Code of Federal Regulation Title 42 - § 431.620 (Relations with State health and vocational rehabilitation agencies and title V grantees)
Title V of the Social Security Act: requires the State Title V and Medicaid programs to coordinate Early Periodic Screening and Treatment (EPSDT) activities “to ensure that such programs are carried out without duplication of effort.” State Title V programs are also required to assist in the identification of “pregnant women and infants” eligible for Medicaid.
(§505(a)(F)(iv))

Early Periodic Screening, Diagnosis and Treatment (EPSDT)

Under the Medicaid program, States are required to provide EPSDT services that provide preventive screening and treatment for children.

States are required to develop a schedule for health, vision and dental screening services for children younger than 21 years of age. These screenings include, but are not limited to, immunizations, laboratory tests, health education, vision services, dental services and hearing services. If a health care problem is discovered in the course of screening, the State is required to provide treatment services even if the service is not covered under the Medicaid State Plan. It is the State’s responsibility to inform eligible beneficiaries that EPSDT services are available and report on the number of screenings and treatment services provided.

State Maternal and Child Health Programs and local health departments can assist Medicaid in reaching all children eligible for EPSDT. Collaboration is required by law, but a strong partnership can ensure that a greater number of children receive these preventative services so that they can live healthier, longer and more productive lives.

Learn more: EPSDT & Title V Collaboration to Improve Child Health