Reimagining EPSDT: A Screen to Support Public Health Strategy for Children with Non-Apparent Disabilities
Keywords:
EPSDT, accessible healthcare, children, Medicaid, health policy, non-apparent disabilities, health policy reformAbstract
Pennsylvania's implementation of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) functions as a compliance-based periodicity schedule rather than a proactive pediatric public health system. Children with non-apparent disabilities, including those with undiagnosed behavioral health conditions, developmental delays, trauma responses, and neurodevelopmental disorders, are routinely missed until they reach crisis, entering systems through emergency departments, special education referrals, or the juvenile justice system.
This policy brief proposes a Screen-to-Support Initiative that transforms EPSDT from a diagnosis-dependent model into a symptom- and function-based early identification and intervention system. Drawing on federal statutory authority and CMS guidance affirming that a formal diagnosis is not a prerequisite for EPSDT services, the authors recommend five reforms: (1) strengthening well-care and interperiodic screening during adolescence; (2) authorizing evaluation and low-intensity intervention based on positive screening results and documented functional impairment rather than confirmed diagnosis; (3) broadening the qualified EPSDT workforce to include behavioral health clinicians, school nurses, social workers, and community health workers; (4) reimbursing care navigation and cross-system coordination as core program functions; and (5) embedding Screen-to-Support accountability metrics into HealthChoices managed care contracts.
The case for reform is compelling. Pennsylvania's 2023 statewide well-care visit rate of 60.21% reflects a significant gap in preventive contact. Nationally, pediatric behavioral health expenditures reached $41.8 billion in 2022, and families of children with disabilities are nearly twice as likely to face health care cost hardship. No new federal legislation is required — Pennsylvania can act now through guidance revisions, contract amendments, and a phased pilot approach.
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Copyright (c) 2026 Jennifer Marazzo, Eric Fishon (Author)
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