MassHealth, Massachusetts' Medicaid program, has begun requiring primary care doctors and nurses to use a standardized behavioral health screening tool at every well-child visit for children under the age of 21.
The new requirement, which took effect Dec. 31, resulted from a 2007 U.S. District Court decision in Rosie D. v. Romney. In its decision, the court ruled that Medicaid-eligible children with “serious emotional disturbances” were not receiving appropriate mental health screenings, service coordination, and home-based treatment services, and ordered MassHealth to implement a plan to improve care.
As such, MassHealth is setting up several initiatives to improve mental health services for Medicaid beneficiaries under age 21 years, said MassHealth spokeswoman Jennifer Kritz in an interview.
For the new standardized behavioral health screens by primary care physicians and nurses, Medicaid will ask providers to choose from eight standardized tools for the screening, depending on the patient's age, and will pay for the screening as well as the standard office visit reimbursement.
The goal is to help detect issues with behavioral health, social-emotional well-being, or mental health in the state's 460,000 children and young adults covered by Medicaid, Ms. Kritz said. If a potential problem is detected, the primary care provider will refer the patient to a mental health provider, according to the state. A parent or guardian can decline screening for a child if they wish.
Other measures prompted by the Rosie D. case will take effect over the next 2 years, Ms. Kritz said. Starting in late 2008, children who see a behavioral health provider will be assessed by that provider using the Child and Adolescent Needs and Strengths tool.
And, MassHealth expects to cover several new behavioral health services for beneficiaries under age 21 years, although the agency hasn't yet received federal approval for those new services, she added.
Massachusetts faces challenges in providing mental health services to those additional children and young adults who are expected to be identified as part of the stepped-up screening, according to the Massachusetts Medicaid Policy Institute.
“Massachusetts faces a shortage of qualified 'child-trained' providers … as well as an inadequate number of bilingual and multicultural providers,” the institute said in a brief last year. “Existing providers also are not spread out evenly across the state, making access a problem in many areas. One of the state's biggest challenges will be to engage more qualified providers and train them in the new delivery structure, which is vastly different from the existing model of care that most clinicians are used to.”
However, Ms. Kritz said MassHealth has a “robust” behavioral health system and is working with primary care physicians to streamline the referral process. It also is partnering with schools and professional organizations to recruit more people to the behavioral health field.