Whatever happened to EPSDT?
Jamie Binder Murray, MS, Chicago
Seven years ago Congress passed into law comprehensive health legislation that promised dental and medical screening, diagnosis, and treatment for all Medicaid-eligible children under age 21. The promise ha§ yet to be kept. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, with all its virtues on paper, has managed to screen, not even treat, only 4% of the 13 million needy children it was intended to benefit. Blame for lack of full implementation has been laid on every sector involved. The states and the Department of Health, Education and Welfare have been ac cused of foot-dragging on the program, while funding limitations and the openended nature of EPSDT, part of the fed eral/state shared Medicaid program, must also take the blame. A dream of a co n ce p t. . . The EPSDT program was a significant step for Medicaid and one that the Amer ican Dental Association applauded. Not only was the program designed to pre vent future serious health problems by detecting and correcting illnesses in the young, but EPSDT also mandated dental care for indigent children under Medi caid for the first time. Dental services had been provided un der some 35 state Medicaid programs, but coverage varied from minimal to moderate. With passage of EPSDT, all
states were required to provide Medicaideligible children under 21 with dental care “ necessary for the relief of pain and infection, the restoration of teeth and the maintenance of dental health.” Since statistics show that 66% of all children from families with incomes less than $4,000 have never been to a dentist, EPSDT had the potential of bringing into the dental care delivery system millions of indigent children and youth.
ment is provided and that periodic recall screening is carried out. Since almost all of the eligible children under this program would require some dental treatment, the ADA suggested that states be allowed to deemphasize dental screening in favor of dental treatment. This Association recommendation was incorporated into the regulations of the law. The EPSDT program mandated the states to establish what was, in effect, a
. . . But a nightmare to Implement Under Medicaid, of which EPSDT is a part, states are required to pay anywhere from 17% to 50% of the program’s cost in the state. The federal government picks up the rest. EPSDT, as far as the states were concerned, would only fur ther drain already overburdened state Medicaid funds. Fear about the pro gram’s potentially high cost has been, from the beginning, the primary reason why EPSDT has not been implemented fully. Although each state was given flexibil ity in the program’s implementation, EPSDT required by law that each state develop, in addition to its regular Medi caid program, an intricate system to iden tify EPSDT eligibles, inform them of the availability of health screening services, and arrange for corrective treatment. The states also were instructed to establish a tracking system to ensure that treat
state health insurance program geared to indigent children populations. But the states simply were not in a position to coordinate and meet the costs of a state wide health program of this dimension, a fact Congress failed to recognize when it passed EPSDT. HEW lack of effort According to a recent General Account ing Office (GAO) investigation of the EPSDT program, a mere 4% of the total EPSDT-eligible population has ever been screened under the program. In a study of eight EPSDT state programs, released Jan 8, the government watchdog agency reports that of the estimated 1.8 million eligible children, only some 58,000 had received physical and dental examina tions. According to an EPSDT staffer, HEW is unable to determine how many children have been treated to date. Rep. Ralph Metcalfe (D-lll), who or dered the GAO investigation, said, “It is JADA, Vol. 90, March 1975 ■ 545
Sen.
W alter F. M o n d a le
(D -M in n )
has been “ d eeply d is tu rb e d a t th e a p p a re n t u n w illin g n e s s o f th e D e p a rt m en t o f HEW to fu lly
im p le m e n t
th e EPSDT p ro g ra m .’ ’ As a c o n se qu e nce , S e n a to rs M on d a le , J a co b K. Javits (R-NY), and 21 o th e r S enate co sp o n so rs in tro d u c e d la st year c o m p re h e n sive ch ild d e v e lo p m e n t le g is la tio n to h e lp m ee t th e n a tio n 's ch ild care needs.
c le a r fro m th is re p o rt th a t HEW was not
ances fo r visual and h e a rin g d e fe cts had
th e least in te re ste d
to be covered.
in p ro v id in g th o se
HEW S e cre tary C aspar W. W e in b e rg e r a d m itte d th a t th e d e p a rtm e n t had to up
T hese re g u la tio n s w ere n o t e ffe ctive
grade its s ta ffin g c o m m itm e n t to EPSDT
over seven years a g o .”
u n til F eb ru a ry 1972, 2Vi years a fte r the
and a n n o u n ce d last A u g u s t th e a ssig n
T he GAO re p o rt also ch a stise s HEW fo r be in g s lo w in d e v e lo p in g re g u la tio n s
p ro g ra m was su p p ose d to be a req u ire d service.
p ro g ra m .
h e a lth services w h ic h w ere m andated by th e
C o n g re ss
C ongress, a w are o f th e d e p a rtm e n t’s
needed to im p le m e n t th e law.
on
issu in g
re g u la tio n s,
m en t o f 125 new s ta ff p o s itio n s fo r the “ W e’re p u ttin g th e fu ll w e ig h t o f o u r reso u rce s b e h in d th is p ro g ra m ,” W ein
U n d e r th e o rig in a l EPSDT statute, s ig n e d in to law on Jan 2, 1968, states
fo o t-d ra g g in g
a u th o rize d th a t a fin a n c ia l p e n a lty clause
b e rg e r said. “ We w a n t to m ake ce rta in
w e re p e rm itte d 18 m o n th s in w h ic h to
be added to EPSDT in an e ffo rt to press
th a t th e se services are a ctu a lly a va il a b le .”
im p le m e n t th e fa r-re a c h in g p ro g ra m . But
th e states in to c o m p lia n c e w ith th e law.
w h e n th e J u ly 1969 d e a d lin e arrived and
The p e n alty w o u ld im p o se a 1% re d u c
HEW had n o t p ro d u c e d d ra ft re g u la tio n s
tio n in fe d era l m a tc h in g w e lfa re fu n d s
to th e law, th e states w ere le ft w ith o u t a
a g a in st any state th a t d id n o t m eet th e
sense o f u rg e n c y on th e m atter. No s e cto r o f g o v e rn m e n t was p ro d d in g th e m in to
re q u ire m e n ts o f th e law. The p e n alty w a s sch e d uled to go in to
a c tio n .
e ffe c t Ju ly 1,1974. B u t again HEW d id not
But, so far, o n ly 20 new sta ffe rs have been hired.
States differ their implementation of EPSDT
issue re g u la tio n s to assess the p e n alty
The GAO re p o rt has p ro m p te d HEW to
clause u n til A u g u s t 1974. In the m ean
a c tio n so th a t now , a fte r seven years, the
a p p re h e n s io n o f th e states, in te rp re te d
tim e,
b ro u g h t
d e p a rtm e n t is b e g in n in g to assess w h ic h
th e law b ro a d ly. A c c o rd in g to th is set of
a g a in st te n sta te s fo r n o t fu lly im p le m e n t
states are n o t in c o m p lia n c e w ith the
p ro p o s e d ru le m a k in g , states w o u ld be re q u ire d to c o rre c t a ilm e n ts reg a rd le ss
ing th e p ro g ra m .
law. F ro m th e re , HEW w ill d e te rm in e a g a in st w h ic h states th e fin a n c ia l p e n a l
o f w h e th e r th e needed tre a tm e n t w as a
its “ a p p a re n t u n w illin g n e s s ” to press these p a rtic u la r states in to c o m p lia n c e
ty w ill be im p ose d .
s e rv ic e u su a lly p ro v id e d u n d e r th a t s ta te ’s M e d ic a id p ro g ra m . The states stro n g ly
and to im p le m e n t th e law.
is tra tio n and c o m m itm e n t to th e EPSDT
F inally, in D e ce m b e r 1970, HEW p u b lish e d
d ra ft re g u la tio n s w h ic h , to
the
p ro te s te d to a d d in g new services to th e ir
c o u rt
su its
had
been
C ritic is m w as levied a g a in st HEW fo r
B ut th e
d e p a rtm e n t
had
m anpow er
L ike M e d ica id in g e n e ra l, state a d m in p ro g ra m
varies. T he
1973 fig u re s fo r
d iffic u ltie s w ith w h ic h it had to c o n te n d .
m on ie s th e sta te s sp e n t to screen one
ic a id c o sts by 1970 w e re s k y ro c k e tin g
M a jo r sta ffe rs re sp o n sib le fo r th e p ro
ch ild ran g e fro m $10 to $70 w ith th e aver
b e yond o rig in a l p ro je c tio n s .
gra m resign e d , leaving o n ly fo u r on board
As a re s u lt o f th e s ta te s’ o b je ctio n s, HEW so fte n e d fin a l EPSDT re g u la tio n s.
in W a sh in g to n to a d m in is te r EPSDT. S u
age fa llin g betw een $ 1 0 and $ 2 0 . The C o u n c il on Dental Care P rogram s
p e rvisio n o f state c o m p lia n c e w ith th e
c o lle cte d d a ta on th e p ro g ra m fro m state
Each state w o u ld be re q u ire d to p ro vid e
law w as be in g h a n dled th ro u g h H EW ’s
so cie tie s in an e ffo rt to d e te rm in e w h a t
o n ly th o s e se rvices th a t it n o rm a lly c o v
ten reg io n a l o ffic e s sta ffed w ith o n ly one
m ade som e EPSDT p ro g ra m s w o rk w h ile
ered u n d e r its M ed ica id p ro g ra m , e xce p t
in d iv id u a l de vo te d
o th e rs d o not.
th a t d e n ta l care and tre a tm e n t and a p p li
region.
w e lfa re p ro g ra m s , e s p e cia lly sin ce M ed
546 ■ JADA, Vol. 90, March 1975
to
EPSDT in
each
C o m m u n ic a tio n ,
c o o p e ra tio n ,
and
a
d e sire to im p le m e n t th e p ro g ra m are p ri
The M ic h ig a n Dental A sso cia tio n re
m ary reasons w h y EPSDT is su cce ssfu l in Alabam a, th e A labam a Dental A sso c ia tio n rep o rts. T he d e n ta l a sso cia tio n
p o rts s im ila r success fo r its s ta te ’s EPS DT p ro g ra m , w h ich began A p ril 1973. S om e $25 m illio n has been b u d ge te d fo r
w as p e rm itte d in p u t in to th e d e sig n o f th e
th e year to serve th e 450,000 e lig ib le EPS
d e n ta l p o rtio n o f th e s ta te ’s p ro g ra m and
DT p o p u la tio n .
m any o f its re c o m m e n d a tio n s have been
E xe cu tive D ire c to r Dr. Jo h n N olen re
in c o rp o ra te d .
th e year,
MDA
p o rts, a ll e lig ib le s w ill have been screened
“ T h e u p s h o t,” re p o rts A labam a Dental A s s o c ia tio n
W ith in
a nd g ro ss d e fe c ts w ill have been treated.
E x e c u tiv e S e cre tary Joyce
New Y o rk ’s la rge EPSDT p o p u la tio n ,
R odgers, “ is rea lly a very g ood p ro g ra m fo r a ll c o n c e rn e d .”
an e stim a te d 1.4 m illio n c h ild re n , is a p p a re n tly a m a jo r o b sta cle to su cce ssful
T he Alabam a d e n ta l p ro g ra m g re w sys
EPSDT im p le m e n ta tio n th e re . It is re
te m a tic a lly , b e g in n in g fo r c h ild re n u n d er
p o rte d th a t o n ly 3% o f th e sta te 's e lig ib le
age 12 in O c to b e r 1972 and th e n phased
c h ild re n
in th e re m a in in g age g ro u p s as th e b u d
s in ce its in a u g u ra tio n in F eb ru a ry 1972.
g e t w o u ld a llo w . C e rtain d e n ta l p ro c e d u re s w ere a p p ro ve d fo r in c lu s io n a t th e
New Y o rk is a tte m p tin g to re s tru c tu re its EPSDT p ro g ra m th ro u g h d e v e lo p m e n t o f
sta rt, b u t p ro c e d u re s are being a d ded to
an
th e p ro g ra m as feasible.
P rogram .
have been served
exp a nsive
C h ild
Health
by EPSDT
A ssurance
A c c o rd in g to Ms. R odgers, o f th e e s tim
A c c o rd in g to th e GAO released in fo r
ated 240,000 e lig ib le EPSDT re c ip ie n ts in th e state, som e 35,000, o r a b o u t 16%,
m a tio n , o n ly 2% o f th e e lig ib le c h ild re n in Illin o is have been reached; W isco n sin and
have received d e ntal trea tm e nt. C ost fo r
O re g o n are co n sid e re d by th e GAO to
th e d e n ta l p o rtio n o f th e A labam a p ro g ra m o ve r th e past 29 m o n th s is m ore th a n
have th e w o rs t EPSDT p ro g ra m s since n e ith e r state had screened any e lig ib le
$3 m illio n .
c h ild re n at th e date o f th e in ve stig a tio n .
Sen. C h a rles H. Percy (R -lll) fa v o rs co o p e ra tiv e
e ffo rts
b e tw een
the
m ed ica l p ro fe s s io n and g o v e rn m e n t to d e ve lo p b e tte r m e th o d s fo r d e liv erin g h e a lth care se rvice s to u n d e r served p e d ia tric p o p u la tio n s .
From EPSDT to NHI W hat is no w needed fro m HEW is a p o s i tive d e c is io n on th e p e rm a n e nce o f th e EPSDT p ro g ra m and th e in ce n tive a va il a b le to states to b e co m e m ore active ly in vo lve d in it. The p e n a lty clause, if im po se d, seem s an u n s a tis fa c to ry so lu tio n s in ce it is n o t lik e ly th a t an ina d e qu a te h e a lth
p ro g ra m
w ill im p ro ve
o n ce its
fu n d s are cu t. A d d itio n a lly , m any states m ay p re fe r to in c u r th e 1% fin a n c ia l p en a lty ra th e r th a n im p le m e n t fu lly an EPSDT p ro g ra m th a t m ig h t co st them m ore. HEW S e cre tary W e in b e rg e r has a d m itte d th a t th e w e ll-m e a n in g EPSDT has n o t been able to live up to th e m ed ica l and d e n ta l needs of th e p o p u la tio n it was in te n d e d to serve. In a m ee tin g held Dec 24, 1974, to d is c u s s th e EPSDT sta ffin g p ro b le m , he a g a in p ro m ise d to up g ra d e th e HEW c o m m itm e n t. The im p lic a tio n s
Rep. Jo n a th a n B. B in g h a m (D-NY) believes it is tim e to be g in “ a new aw areness o f th e need fo r better h e a lth care fo r o u r c h ild re n and a
Sen. H u b e rt H. H u m p h re y (D -M inn),
th a t can be d ra w n fro m th e d e p a rtm e n t’s
c h a ra c te riz in g th e N ixo n a d m in is tra
in a b ility to de ve lo p, a fte r seven years, a w o rk in g p ro g ra m fo r 13 m illio n c h ild re n ,
t io n ’s c o m m itm e n t to im p ro v in g c h ild h e a lth ca re as “ p ro c ra s tin a
w h ile it is c o n te m p la tin g a n a tio n a l health
tio n ,” in tro d u c e d th e C h ild and M a
in s u ra n c e plan fo r so m e 210 m illio n , are
te rn a l
o b vio u s.
w h ic h w o u ld
H ealth
C are
E xte n s io n A c t
a u th o riz e a d e c is iv e
fe d e ra l re sp o n se to th e d e fic ie n c ie s
new d e te rm in a tio n to a c t.”
o f th e EPSDT p ro g ra m . Ms. M urray is staff assodate, C ouncil on Den tai Care Programs.
Jamie Binder Murray, MS, Chicago
Seven years ago Congress passed into law comprehensive health legislation that promised dental and medical screening, diagnosis, and treatment for all Medicaid-eligible children under age 21. The promise ha§ yet to be kept. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, with all its virtues on paper, has managed to screen, not even treat, only 4% of the 13 million needy children it was intended to benefit. Blame for lack of full implementation has been laid on every sector involved. The states and the Department of Health, Education and Welfare have been ac cused of foot-dragging on the program, while funding limitations and the openended nature of EPSDT, part of the fed eral/state shared Medicaid program, must also take the blame. A dream of a co n ce p t. . . The EPSDT program was a significant step for Medicaid and one that the Amer ican Dental Association applauded. Not only was the program designed to pre vent future serious health problems by detecting and correcting illnesses in the young, but EPSDT also mandated dental care for indigent children under Medi caid for the first time. Dental services had been provided un der some 35 state Medicaid programs, but coverage varied from minimal to moderate. With passage of EPSDT, all
states were required to provide Medicaideligible children under 21 with dental care “ necessary for the relief of pain and infection, the restoration of teeth and the maintenance of dental health.” Since statistics show that 66% of all children from families with incomes less than $4,000 have never been to a dentist, EPSDT had the potential of bringing into the dental care delivery system millions of indigent children and youth.
ment is provided and that periodic recall screening is carried out. Since almost all of the eligible children under this program would require some dental treatment, the ADA suggested that states be allowed to deemphasize dental screening in favor of dental treatment. This Association recommendation was incorporated into the regulations of the law. The EPSDT program mandated the states to establish what was, in effect, a
. . . But a nightmare to Implement Under Medicaid, of which EPSDT is a part, states are required to pay anywhere from 17% to 50% of the program’s cost in the state. The federal government picks up the rest. EPSDT, as far as the states were concerned, would only fur ther drain already overburdened state Medicaid funds. Fear about the pro gram’s potentially high cost has been, from the beginning, the primary reason why EPSDT has not been implemented fully. Although each state was given flexibil ity in the program’s implementation, EPSDT required by law that each state develop, in addition to its regular Medi caid program, an intricate system to iden tify EPSDT eligibles, inform them of the availability of health screening services, and arrange for corrective treatment. The states also were instructed to establish a tracking system to ensure that treat
state health insurance program geared to indigent children populations. But the states simply were not in a position to coordinate and meet the costs of a state wide health program of this dimension, a fact Congress failed to recognize when it passed EPSDT. HEW lack of effort According to a recent General Account ing Office (GAO) investigation of the EPSDT program, a mere 4% of the total EPSDT-eligible population has ever been screened under the program. In a study of eight EPSDT state programs, released Jan 8, the government watchdog agency reports that of the estimated 1.8 million eligible children, only some 58,000 had received physical and dental examina tions. According to an EPSDT staffer, HEW is unable to determine how many children have been treated to date. Rep. Ralph Metcalfe (D-lll), who or dered the GAO investigation, said, “It is JADA, Vol. 90, March 1975 ■ 545
Sen.
W alter F. M o n d a le
(D -M in n )
has been “ d eeply d is tu rb e d a t th e a p p a re n t u n w illin g n e s s o f th e D e p a rt m en t o f HEW to fu lly
im p le m e n t
th e EPSDT p ro g ra m .’ ’ As a c o n se qu e nce , S e n a to rs M on d a le , J a co b K. Javits (R-NY), and 21 o th e r S enate co sp o n so rs in tro d u c e d la st year c o m p re h e n sive ch ild d e v e lo p m e n t le g is la tio n to h e lp m ee t th e n a tio n 's ch ild care needs.
c le a r fro m th is re p o rt th a t HEW was not
ances fo r visual and h e a rin g d e fe cts had
th e least in te re ste d
to be covered.
in p ro v id in g th o se
HEW S e cre tary C aspar W. W e in b e rg e r a d m itte d th a t th e d e p a rtm e n t had to up
T hese re g u la tio n s w ere n o t e ffe ctive
grade its s ta ffin g c o m m itm e n t to EPSDT
over seven years a g o .”
u n til F eb ru a ry 1972, 2Vi years a fte r the
and a n n o u n ce d last A u g u s t th e a ssig n
T he GAO re p o rt also ch a stise s HEW fo r be in g s lo w in d e v e lo p in g re g u la tio n s
p ro g ra m was su p p ose d to be a req u ire d service.
p ro g ra m .
h e a lth services w h ic h w ere m andated by th e
C o n g re ss
C ongress, a w are o f th e d e p a rtm e n t’s
needed to im p le m e n t th e law.
on
issu in g
re g u la tio n s,
m en t o f 125 new s ta ff p o s itio n s fo r the “ W e’re p u ttin g th e fu ll w e ig h t o f o u r reso u rce s b e h in d th is p ro g ra m ,” W ein
U n d e r th e o rig in a l EPSDT statute, s ig n e d in to law on Jan 2, 1968, states
fo o t-d ra g g in g
a u th o rize d th a t a fin a n c ia l p e n a lty clause
b e rg e r said. “ We w a n t to m ake ce rta in
w e re p e rm itte d 18 m o n th s in w h ic h to
be added to EPSDT in an e ffo rt to press
th a t th e se services are a ctu a lly a va il a b le .”
im p le m e n t th e fa r-re a c h in g p ro g ra m . But
th e states in to c o m p lia n c e w ith th e law.
w h e n th e J u ly 1969 d e a d lin e arrived and
The p e n alty w o u ld im p o se a 1% re d u c
HEW had n o t p ro d u c e d d ra ft re g u la tio n s
tio n in fe d era l m a tc h in g w e lfa re fu n d s
to th e law, th e states w ere le ft w ith o u t a
a g a in st any state th a t d id n o t m eet th e
sense o f u rg e n c y on th e m atter. No s e cto r o f g o v e rn m e n t was p ro d d in g th e m in to
re q u ire m e n ts o f th e law. The p e n alty w a s sch e d uled to go in to
a c tio n .
e ffe c t Ju ly 1,1974. B u t again HEW d id not
But, so far, o n ly 20 new sta ffe rs have been hired.
States differ their implementation of EPSDT
issue re g u la tio n s to assess the p e n alty
The GAO re p o rt has p ro m p te d HEW to
clause u n til A u g u s t 1974. In the m ean
a c tio n so th a t now , a fte r seven years, the
a p p re h e n s io n o f th e states, in te rp re te d
tim e,
b ro u g h t
d e p a rtm e n t is b e g in n in g to assess w h ic h
th e law b ro a d ly. A c c o rd in g to th is set of
a g a in st te n sta te s fo r n o t fu lly im p le m e n t
states are n o t in c o m p lia n c e w ith the
p ro p o s e d ru le m a k in g , states w o u ld be re q u ire d to c o rre c t a ilm e n ts reg a rd le ss
ing th e p ro g ra m .
law. F ro m th e re , HEW w ill d e te rm in e a g a in st w h ic h states th e fin a n c ia l p e n a l
o f w h e th e r th e needed tre a tm e n t w as a
its “ a p p a re n t u n w illin g n e s s ” to press these p a rtic u la r states in to c o m p lia n c e
ty w ill be im p ose d .
s e rv ic e u su a lly p ro v id e d u n d e r th a t s ta te ’s M e d ic a id p ro g ra m . The states stro n g ly
and to im p le m e n t th e law.
is tra tio n and c o m m itm e n t to th e EPSDT
F inally, in D e ce m b e r 1970, HEW p u b lish e d
d ra ft re g u la tio n s w h ic h , to
the
p ro te s te d to a d d in g new services to th e ir
c o u rt
su its
had
been
C ritic is m w as levied a g a in st HEW fo r
B ut th e
d e p a rtm e n t
had
m anpow er
L ike M e d ica id in g e n e ra l, state a d m in p ro g ra m
varies. T he
1973 fig u re s fo r
d iffic u ltie s w ith w h ic h it had to c o n te n d .
m on ie s th e sta te s sp e n t to screen one
ic a id c o sts by 1970 w e re s k y ro c k e tin g
M a jo r sta ffe rs re sp o n sib le fo r th e p ro
ch ild ran g e fro m $10 to $70 w ith th e aver
b e yond o rig in a l p ro je c tio n s .
gra m resign e d , leaving o n ly fo u r on board
As a re s u lt o f th e s ta te s’ o b je ctio n s, HEW so fte n e d fin a l EPSDT re g u la tio n s.
in W a sh in g to n to a d m in is te r EPSDT. S u
age fa llin g betw een $ 1 0 and $ 2 0 . The C o u n c il on Dental Care P rogram s
p e rvisio n o f state c o m p lia n c e w ith th e
c o lle cte d d a ta on th e p ro g ra m fro m state
Each state w o u ld be re q u ire d to p ro vid e
law w as be in g h a n dled th ro u g h H EW ’s
so cie tie s in an e ffo rt to d e te rm in e w h a t
o n ly th o s e se rvices th a t it n o rm a lly c o v
ten reg io n a l o ffic e s sta ffed w ith o n ly one
m ade som e EPSDT p ro g ra m s w o rk w h ile
ered u n d e r its M ed ica id p ro g ra m , e xce p t
in d iv id u a l de vo te d
o th e rs d o not.
th a t d e n ta l care and tre a tm e n t and a p p li
region.
w e lfa re p ro g ra m s , e s p e cia lly sin ce M ed
546 ■ JADA, Vol. 90, March 1975
to
EPSDT in
each
C o m m u n ic a tio n ,
c o o p e ra tio n ,
and
a
d e sire to im p le m e n t th e p ro g ra m are p ri
The M ic h ig a n Dental A sso cia tio n re
m ary reasons w h y EPSDT is su cce ssfu l in Alabam a, th e A labam a Dental A sso c ia tio n rep o rts. T he d e n ta l a sso cia tio n
p o rts s im ila r success fo r its s ta te ’s EPS DT p ro g ra m , w h ich began A p ril 1973. S om e $25 m illio n has been b u d ge te d fo r
w as p e rm itte d in p u t in to th e d e sig n o f th e
th e year to serve th e 450,000 e lig ib le EPS
d e n ta l p o rtio n o f th e s ta te ’s p ro g ra m and
DT p o p u la tio n .
m any o f its re c o m m e n d a tio n s have been
E xe cu tive D ire c to r Dr. Jo h n N olen re
in c o rp o ra te d .
th e year,
MDA
p o rts, a ll e lig ib le s w ill have been screened
“ T h e u p s h o t,” re p o rts A labam a Dental A s s o c ia tio n
W ith in
a nd g ro ss d e fe c ts w ill have been treated.
E x e c u tiv e S e cre tary Joyce
New Y o rk ’s la rge EPSDT p o p u la tio n ,
R odgers, “ is rea lly a very g ood p ro g ra m fo r a ll c o n c e rn e d .”
an e stim a te d 1.4 m illio n c h ild re n , is a p p a re n tly a m a jo r o b sta cle to su cce ssful
T he Alabam a d e n ta l p ro g ra m g re w sys
EPSDT im p le m e n ta tio n th e re . It is re
te m a tic a lly , b e g in n in g fo r c h ild re n u n d er
p o rte d th a t o n ly 3% o f th e sta te 's e lig ib le
age 12 in O c to b e r 1972 and th e n phased
c h ild re n
in th e re m a in in g age g ro u p s as th e b u d
s in ce its in a u g u ra tio n in F eb ru a ry 1972.
g e t w o u ld a llo w . C e rtain d e n ta l p ro c e d u re s w ere a p p ro ve d fo r in c lu s io n a t th e
New Y o rk is a tte m p tin g to re s tru c tu re its EPSDT p ro g ra m th ro u g h d e v e lo p m e n t o f
sta rt, b u t p ro c e d u re s are being a d ded to
an
th e p ro g ra m as feasible.
P rogram .
have been served
exp a nsive
C h ild
Health
by EPSDT
A ssurance
A c c o rd in g to Ms. R odgers, o f th e e s tim
A c c o rd in g to th e GAO released in fo r
ated 240,000 e lig ib le EPSDT re c ip ie n ts in th e state, som e 35,000, o r a b o u t 16%,
m a tio n , o n ly 2% o f th e e lig ib le c h ild re n in Illin o is have been reached; W isco n sin and
have received d e ntal trea tm e nt. C ost fo r
O re g o n are co n sid e re d by th e GAO to
th e d e n ta l p o rtio n o f th e A labam a p ro g ra m o ve r th e past 29 m o n th s is m ore th a n
have th e w o rs t EPSDT p ro g ra m s since n e ith e r state had screened any e lig ib le
$3 m illio n .
c h ild re n at th e date o f th e in ve stig a tio n .
Sen. C h a rles H. Percy (R -lll) fa v o rs co o p e ra tiv e
e ffo rts
b e tw een
the
m ed ica l p ro fe s s io n and g o v e rn m e n t to d e ve lo p b e tte r m e th o d s fo r d e liv erin g h e a lth care se rvice s to u n d e r served p e d ia tric p o p u la tio n s .
From EPSDT to NHI W hat is no w needed fro m HEW is a p o s i tive d e c is io n on th e p e rm a n e nce o f th e EPSDT p ro g ra m and th e in ce n tive a va il a b le to states to b e co m e m ore active ly in vo lve d in it. The p e n a lty clause, if im po se d, seem s an u n s a tis fa c to ry so lu tio n s in ce it is n o t lik e ly th a t an ina d e qu a te h e a lth
p ro g ra m
w ill im p ro ve
o n ce its
fu n d s are cu t. A d d itio n a lly , m any states m ay p re fe r to in c u r th e 1% fin a n c ia l p en a lty ra th e r th a n im p le m e n t fu lly an EPSDT p ro g ra m th a t m ig h t co st them m ore. HEW S e cre tary W e in b e rg e r has a d m itte d th a t th e w e ll-m e a n in g EPSDT has n o t been able to live up to th e m ed ica l and d e n ta l needs of th e p o p u la tio n it was in te n d e d to serve. In a m ee tin g held Dec 24, 1974, to d is c u s s th e EPSDT sta ffin g p ro b le m , he a g a in p ro m ise d to up g ra d e th e HEW c o m m itm e n t. The im p lic a tio n s
Rep. Jo n a th a n B. B in g h a m (D-NY) believes it is tim e to be g in “ a new aw areness o f th e need fo r better h e a lth care fo r o u r c h ild re n and a
Sen. H u b e rt H. H u m p h re y (D -M inn),
th a t can be d ra w n fro m th e d e p a rtm e n t’s
c h a ra c te riz in g th e N ixo n a d m in is tra
in a b ility to de ve lo p, a fte r seven years, a w o rk in g p ro g ra m fo r 13 m illio n c h ild re n ,
t io n ’s c o m m itm e n t to im p ro v in g c h ild h e a lth ca re as “ p ro c ra s tin a
w h ile it is c o n te m p la tin g a n a tio n a l health
tio n ,” in tro d u c e d th e C h ild and M a
in s u ra n c e plan fo r so m e 210 m illio n , are
te rn a l
o b vio u s.
w h ic h w o u ld
H ealth
C are
E xte n s io n A c t
a u th o riz e a d e c is iv e
fe d e ra l re sp o n se to th e d e fic ie n c ie s
new d e te rm in a tio n to a c t.”
o f th e EPSDT p ro g ra m . Ms. M urray is staff assodate, C ouncil on Den tai Care Programs.
