{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:20:43Z","timestamp":1791670843659,"version":"4.3.4"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Medicaid-enrolled children are entitled to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits, which include general and behavioral health (BH) screenings. Adolescents remain among the least likely to receive recommended screenings, and little is known about how screening delivery varies across plans or aligns with plan quality ratings.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To examine trends in general and BH screenings under EPSDT among adolescents aged 12 to 18 years in New York Medicaid managed care and to assess whether screening performance differs by managed care organization (MCO) quality ratings.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study used New York Medicaid administrative data from January 2016 to December 2021, including enrollment and claims from the Transformed Medicaid Statistical Information System analytic files. During the study period, reporting of BH screening was voluntary. The study included adolescents aged 12 to 18 years who were continuously enrolled for at least 6 months in a given calendar year. Data analysis was conducted from March 2025 to January 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Enrollment as an adolescent in a Medicaid MCO in New York State.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Claims-based measures of utilization of general and BH screenings consistent with EPSDT services. The primary measures were (1) the percentage of adolescents receiving at least 1 general screening and (2) the percentage receiving at least 1 BH screening during a calendar year. In a supplemental analysis, the correlation between general and BH EPSDT screening rates was tested.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This cross-sectional study included 1\u202f562\u202f342 unique adolescents aged 12 to 18 years enrolled in New York Medicaid from 2016 to 2021 (mean [SD] age, 14.9 [2.0] years; 761\u202f203 [48.7%] female; 7629 [0.5%] American Indian or Alaska Native; 148\u202f576 [9.5%] Asian American or Pacific Islander; 286\u202f003 [18.3%] Black; 204\u202f340 [13.1%] Hispanic; 403\u202f490 [25.8%] White; 512\u202f304 [32.8%] additional groups or missing information). General EPSDT screening rates ranged from 52.5% to 61.0% annually, with the lowest rate observed in 2020 during the onset of the COVID-19 pandemic. BH screening rates increased over time, from 7.7% in 2016 to 21.2% in 2021, but remained substantially lower than general EPSDT screening rates, reaching only about one-third of general screening rates. Screening rates were highest for mid-adolescents (ages 14-16 years) and lowest for ages 12 and 18 years. Across MCOs, general screening rates were relatively consistent, whereas BH screening rates varied widely, with only moderate correlation between the 2 screening types at the plan level (Pearson\n r<\/jats:italic>\n \u2009=\u20090.47). BH performance showed little alignment with state-assigned MCO quality ratings.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of adolescents in New York Medicaid from 2016 to 2021, BH screening rates remained far lower than general EPSDT screening rates, with wide variation across MCOs and limited alignment with state-assigned MCO quality ratings. These gaps may reflect long-standing structural challenges, including previously voluntary reporting of adolescent depression screening by the Centers for Medicare &amp;amp; Medicaid Services under the Mandatory Core Set of Behavioral Health Measures for Medicaid and Children\u2019s Health Insurance Program. Incorporating now-mandatory BH measures into MCO performance benchmarks could increase adolescent BH screening rates, strengthen accountability, support earlier detection of mental health conditions, and reduce variation in preventive care delivery both in New York and nationwide.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.3060","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T15:00:17Z","timestamp":1774364417000},"page":"e263060","source":"Crossref","is-referenced-by-count":1,"title":["General and Behavioral Health Screening Under EPSDT for Adolescents in New York Medicaid Managed Care"],"prefix":"10.1001","volume":"9","author":[{"given":"Rachel","family":"Rosales","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Meyers","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. John","family":"McConnell","sequence":"additional","affiliation":[{"name":"Center for Health Systems Effectiveness, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Flores","sequence":"additional","affiliation":[{"name":"Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Feinberg","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice and Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Burke Bryant","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice and Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Gal\u00e1rraga","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Population Studies and Training Center (PSTC), Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"issue":"16","key":"zoi260128r1","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1056\/NEJMp2415618","article-title":"EPSDT\u2014Medicaid\u2019s mandate for children and adolescents.","volume":"392","author":"Perrin","year":"2025","journal-title":"N Engl J 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EPSDT is Essential. National Health Law Program. March 14, 2017. Accessed February 10, 2026. https:\/\/healthlaw.org\/resource\/epsdt-is-essential\/"},{"key":"zoi260128r3","unstructured":"MACPAC. EPSDT in Medicaid. January 12, 2021. Accessed February 10, 2026. https:\/\/www.macpac.gov\/subtopic\/epsdt-in-medicaid\/"},{"key":"zoi260128r4","unstructured":"Perkins J, Avery A. EPSDT litigation trends and annotated docket. National Health Law Program. May 10, 2023. Accessed February 10, 2026. https:\/\/healthlaw.org\/resource\/epsdt-litigation-trends-and-annotated-docket\/"},{"key":"zoi260128r5","unstructured":"Centers for Medicare and Medicaid Services. Best practices for adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements. September 26, 2024. Accessed February 10, 2026. https:\/\/www.medicaid.gov\/federal-policy-guidance\/downloads\/sho24005.pdf"},{"key":"zoi260128r6","unstructured":"Centers for Medicare and Medicaid Services. EPSDT\u2014a guide for states: coverage in the Medicaid benefit for children and adolescents. June 2014. Accessed February 10, 2026. https:\/\/www.medicaid.gov\/medicaid\/benefits\/downloads\/epsdt-coverage-guide.pdf"},{"key":"zoi260128r8","unstructured":"Centers for Medicare and Medicaid Services. Well-Child Care. February 10, 2026. https:\/\/www.medicaid.gov\/medicaid\/quality-of-care\/quality-improvement-initiatives\/well-child-care"},{"key":"zoi260128r9","unstructured":"American Academy of Pediatrics. Preventive care\/periodicity schedule. Accessed December 3, 2025. https:\/\/www.aap.org\/en\/practice-management\/care-delivery-approaches\/periodicity-schedule\/"},{"key":"zoi260128r12","unstructured":"Williams E, Burns A, Rudowitz R, Drake P. The impact of the pandemic on well-child visits for children enrolled in Medicaid and CHIP. KFF. March 18, 2024. Accessed December 5, 2025. https:\/\/www.kff.org\/medicaid\/the-impact-of-the-pandemic-on-well-child-visits-for-children-enrolled-in-medicaid-and-chip\/"},{"key":"zoi260128r13","unstructured":"New York Department of Health. Medicaid state plan provider manual for children\u2019s BH early and periodic screening and diagnostic testing (EPSDT) services. December 6, 2016. Accessed February 11, 2026. https:\/\/www.health.ny.gov\/health_care\/medicaid\/redesign\/behavioral_health\/children\/docs\/2016-12-06_draft_spa_prov_manual.pdf"},{"key":"zoi260128r16","unstructured":"Perkins J. Fact Sheet EPSDT Litigation Trends & Docket. National Health Law Program. October 13, 2020. Accessed February 11, 2026. https:\/\/healthlaw.org\/resource\/fact-sheet-epsdt-litigation-trends-docket\/"},{"key":"zoi260128r17","unstructured":"MACPAC. Access to behavioral health services for children and adolescents covered by Medicaid and CHIP. June 2021. Accessed February 11, 2026. https:\/\/www.macpac.gov\/wp-content\/uploads\/2021\/06\/Chapter-3-Access-to-Behavioral-Health-Services-for-Children-and-Adolescents-Covered-by-Medicaid-and-CHIP.pdf"},{"key":"zoi260128r23","unstructured":"Alker J, Dwyer A. CMS issues guidance to states on early and periodic screening, diagnostic and treatment requirements. Center For Children and Families. September 26, 2024. Accessed August 15, 2025. https:\/\/ccf.georgetown.edu\/2024\/09\/26\/cms-issues-guidance-to-states-on-early-and-periodic-screening-diagnostic-and-treatment-requirements\/"},{"key":"zoi260128r25","unstructured":"Tsai D; Center for Medicaid and CHIP Services (CMCS). Leveraging Medicaid, CHIP, and other federal programs in the delivery of behavioral health services for children and youth. August 18, 2022. Accessed February 11, 2026. https:\/\/www.medicaid.gov\/federal-policy-guidance\/downloads\/bhccib08182022.pdf"},{"key":"zoi260128r26","unstructured":"Forum on Promoting Children\u2019s Cognitive, Affective, and Behavioral Health; Board on Children, Youth, and Families; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine. Early identification and interventions for youth and adolescents with serious behavioral health conditions. In: Ensuring Quality and Accessible Care for Children with Disabilities and Complex Health and Educational Needs: Proceedings of a Workshop. National Academies Press; 2016. Accessed February 11, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK395960\/"},{"key":"zoi260128r28","unstructured":"Brooks T. Medicaid and CHIP Provide Health Coverage to More than Half of Children of Color. Center For Children and Families. July 27, 2020. Accessed November 23, 2025. https:\/\/ccf.georgetown.edu\/2020\/07\/27\/medicaid-and-chip-provide-health-coverage-to-more-than-half-of-children-of-color\/"},{"key":"zoi260128r29","unstructured":"MACStats. Exhibit 30: percentage of Medicaid enrollees in managed care by state and eligibility group, FY 2021. February 2023. Accessed February 11, 2026. https:\/\/www.macpac.gov\/wp-content\/uploads\/2023\/10\/EXHIBIT-30.-Percentage-of-Medicaid-Enrollees-in-Managed-Care-by-State-and-Eligibility-Group-FY-2021.pdf"},{"key":"zoi260128r30","unstructured":"Thompson? V. How state Medicaid programs serve children and youth in foster care. NASHP. May 24, 2022. Accessed August 14, 2025. https:\/\/nashp.org\/how-state-medicaid-programs-serve-children-and-youth-in-foster-care\/"},{"key":"zoi260128r31","unstructured":"New York State Department of Health. eQARR\u2014an online report on quality performance results for health plans in New York State. 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Accessed February 11, 2026. https:\/\/www.medicaid.gov\/medicaid\/benefits\/downloads\/cms-416-instructions.pdf"},{"key":"zoi260128r36","unstructured":"New York State Department of Health. Children and family treatment and support services (CFTSS) provider manual for EPSDT services. August 2025. Accessed February 11, 2026. https:\/\/www.health.ny.gov\/health_care\/medicaid\/redesign\/behavioral_health\/children\/docs\/updated_spa_manual.pdf"},{"key":"zoi260128r38","unstructured":"ASPE. Behavioral health service use among Medicaid and CHIP enrollees before\/during the COVID-19 public health emergency. January 8, 2025. Accessed November 25, 2025. http:\/\/aspe.hhs.gov\/reports\/bh-service-use-among-medicaidchip-enrollees-beforeduring-covid-19-phe"},{"key":"zoi260128r41","unstructured":"Office of the Inspector General. Series: states\u2019 Medicaid eligibility and enrollment actions concluding the COVID-19 public health emergency. Updated August 27, 2024. 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Children\u2019s health care quality measures. Accessed December 4, 2025. https:\/\/www.medicaid.gov\/medicaid\/quality-of-care\/performance-measurement\/adult-and-child-health-care-quality-measures\/childrens-health-care-quality-measures"},{"key":"zoi260128r46","unstructured":"Centers for Medicare & Medicaid Services. CMS approves New York\u2019s groundbreaking section 1115 demonstration amendment to improve primary care, behavioral health, and health equity. 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