Newswise — Expansion of Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program in California has significantly improved children's access to mental health services, reports a study in the June issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

The gains appear greatest in rural communities and areas with historically low levels of state funding for mental health services, where children living in poverty have high rates of mental health issues that are not appropriately treated. The lead author was Lonnie R. Snowden, Ph.D., of University of California, Berkeley.

Under a 1995 expansion of the EPSDT program, mental health benefits were "carved out" from other EPSDT benefits and assigned to California county mental health plans. Mental health benefits paid by Medi-Cal (the California Medicaid program) increased sharply after the expansion—from $121 million in 1994-95 to $446 million in 1999-2000—with increased use of outpatient treatment and reduced use of crisis services.

The current study focused on how the changes affected children's access to mental health services—a major goal of the EPSDT expansion. The analysis included data from 53 county mental health plans from 1992-93 to 2001-02.

BIGGEST GAINS IN RURAL AREAS AND OTHER UNDER-SERVED COMMUNITIESThe expansion was followed by rapid increases in "penetration rates," a key indicator of treatment access. Within one year EPSDT expansion and increased funding, penetration rates increased by 38 percent in rural counties, compared to 18 percent in urban areas. In counties that had previously lagged behind in state funding for mental health care, the increase was 49 percent.

Counties with more foster children eligible for Medi-Cal services also showed greater increases. This reflected policy changes designed to detect and treat problems in these groups of children. "As a result of these changes, many mental health plans began to actively seek cases more than in the past," Dr. Snowden and colleagues write. "Rather than waiting for regular EPSDT screening and mental health referral, they reached out to social service, educational, and other community programs and directly sought children with mental health problems."

Under EPSDT, the states are required to help pay for mental health screening in children, as well as for any medically necessary treatment. The expansion of EPSDT in California resulted from an advocacy-initiated lawsuit to force the state to provide these mandated services.

The EPSDT "carve-out" and other measures—including protection against cost increases for county mental health plans—appear to have succeeded in improving access to mental health care for children in need. Other states now face similar lawsuits for not providing EPSDT services, many because of failure to provide access to mental and behavioral health care.

Despite the improvement, children's access to mental health care in California still lags behind reported averages in most other states. The researchers conclude, "Children continue to have considerable unmet need for mental health treatment, and more research is needed to identify reasons for continuing low penetration rates and additional steps that might raise them even more."

About Medical CareRated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association. Visit the journal website at

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins ( is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company with annual revenues (2007) of €3.4 billion ($4.8 billion), maintains operations in over 33 countries across Europe, North America, and Asia Pacific and employs approximately 19,500 people worldwide. Visit for information about our market positions, customers, brands, and organization.

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