Expansion of Medicaid Services for Children and Families

One of the themes developed by the Children’s Medicaid Redesign Team (MRT) Subcommittee included the desire to improve the children’s service system, including the expansion of children’s benefits under Medicaid. The vision of the design is a children’s system where we:

  • intervene early in the progression of behavioral and physical health needs to achieve better outcomes at less lifetime cost;
  • are accountable for outcomes across all payers; and
  • have solutions to address the unique needs of children in a unified, integrated approach.

The Office of Mental Health (OMH), Office of Alcoholism and Substance Abuse Services (OASAS), Office of Children and Family Services (OCFS), and the Department of Health (DOH) jointly established six new Medicaid services to benefit New York State’s children from birth up to 21 years of age. Rather than establishing a separately licensed program, New York is developing these children State Plan Amendment (SPA) services under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) section of Medicaid. This gives greater flexibility to providers in designing service models and in incorporating these services in creative ways with children’s schools, homes and community connections. These six services will be available to any child eligible for Medicaid who meets relevant medical necessity criteria and has a treatment plan with identified goals and objectives. SPA services enable child-serving agencies to focus on prevention and wellness and improving integration of behavioral health and health focused services earlier in a child’s life. The array of services will allow interventions to be delivered in natural community-based settings where children and their families live, go to school and play.

The services are:

  • Crisis Intervention; 
  • Community Psychiatric Supports & Treatment; 
  • Family Peer Support Services; 
  • Youth Peer Advocacy and Training; 
  • Other Licensed Practitioners; and
  • Psychosocial Rehabilitation Services.

Many in the children’s system hold out great promise in SPA services, including their ability to create a strong replacement for current school-based mental health clinics. There has long been a seemingly insurmountable crevasse between the requirements of an OMH-licensed mental health school-based clinic and the needs of the school/children, the ability to engage families and even the mismatch of session times with classroom periods. SPA services provide a pathway to achieve outcomes for kids by delivering engaging, evidence-based services that mesh with the school day and have the capacity to reach out to families. All of this with what we hope will be a reasonable financial model. The table in the following link is designed to reflect the creative application of SPA services to identifying and intervening earlier with children and adolescents: SAE SPA Services Table and Timeline 2016.

NYS has not yet released rates for the SPA services. A final SPA manual with detail on how agencies can apply for designation as a SPA provider is anticipated in the Fall of 2016, with the State’s target of service onset in January 2017.

This Issue Brief was written by Kristin Woodlock, RN, MPA, who has over 30 years of experience in State and County governments and nonprofits. She has extensive experience in Commissioner positions in New York, including the lead in Children’s Behavioral Healthcare. She has operated inpatient, outpatient and community services for children and co-authored The Children’s Plan.