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Increasing California Children's Medicaid-Financed Mental Health Treatment by Vigorously Implementing Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

Snowden, Lonnie R. PhD*; Masland, Mary PhD; Wallace, Neal PhD; Fawley-King, Kya MSW*; Cuellar, Alison Evans PhD§

doi: 10.1097/MLR.0b013e3181648e82
Original Article

Background: Children living in poverty—especially children living in rural areas and in areas lacking a commitment to providing mental health care—have considerable unmet need for mental health treatment. Expansion of Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program might help to address this problem.

Objective: To evaluate whether a legally compelled expansion of mental health screening, treatment, and financing under EPSDT would translate into higher Medicaid penetration rates. Our particular focus was on changes in rural treatment systems and systems historically receiving low levels of state funding (ie, “underequity” counties).

Methods: We used fixed-effects regression methods by observing 53 California county mental health plans over 36 quarters, yielding 1908 observations. Our models controlled for all static, county, and service system characteristics, and for ongoing linear trends in penetration rates.

Results: After controlling for previous trends, mental health treatment access increased following EPSDT mental health program expansion. The increase was greatest in rural systems, and counties that previously received less state funding which showed the greatest penetration rate increases.

Conclusions: EPSDT mental health expansion and increased funding increased Medicaid-financed mental health treatment. The expansion efforts had the greatest effects in rural and underequity counties that faced the greatest barriers to mental health service use.

From the *School of Social Welfare and Center for Mental Health Services Research, University of California, Berkeley, California; †Center for Mental Health Services Research, University of California, Berkeley, California; ‡Mark O. Hatfield School of Government, Portland State University, Portland, Oregon; and §Department of Health and Policy Management, Columbia University, New York, New York.

Reprints: Lonnie R. Snowden, PhD, 120 Haviland Hall, University of California, Berkeley, CA 94720-7400. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.