EPSDT vs Wraparound

Almost nobody knows that, regardless of family income, children in states like Pennsylvania who do not yet have Medical Assistance (Medicaid) benefits but do have a mental disability (autism, ADHD, etc) can get an expert psychological evaluation at no cost whatsoever, and that treatment (Behavior Specialist consultations and Mobile Therapy services) can often be started almost immediately following the evaluation if these services may be of help to the child.  These services, provided under the supervision of a licensed professional psychologist,  may be available to disabled children at no cost whatsoever, in 36 (or more) other states as well.

Some people mistakenly refer to these federally mandated EPSDT “Behavioral Health Rehabilitation” (BHR) services delivered under Medicaid as “wraparound” services, but there are at least two significant differences:  1) There is simply no need to wait for any insurance company to give its “permission” for a child to begin receiving these EPSDT BHR services if he/she lives in a state like Pennsylvania where they are routinely prescribed, has a diagnosed mental illness, is under the age of 21, and does not yet have Medical Assistance benefits, and 2) in some states like Pennsylvania, these services are available via Medicaid to every child with a mental disability, regardless of family income.  EPSDT services are federally mandated treatment opportunities that are available to disabled children in all 50 states (although not all states have implemented BHR services as conscientiously as Pennsylvania); “Wraparound” is a treatment philosophy

Tremendous opportunities for licensed psychologists to direct and supervise the delivery of these services exist, in Pennsylvania and elsewhere.  As a licensed psychologist since 1981, I have been providing these services to Pennsylvania children very successfully, and currently direct one of the largest private practices of psychology in Pennsylvania dedicated exclusively to improving children’s mental and behavioral health.  The Institute for Behavior Change, where the staff who provide these services are trained, has been recognized by the Pennsylvania Psychological Association (PPA) Psychologically Healthy Workplace Award program for its exceptional Employee Career Development activities.  I look forward to speaking with interested colleagues about the evolution of psychology as a profession and all of the wonderful opportunities that EPSDT BHR service delivery can create for children, adolescents and the professionals who treat them. 

Steve Kossor
Executive Director
The Institute for Behavior Change

The following Power Point presentation has been converted into an extensively notated PDF file.  You are free to copy this presentation file and distribute it to others, as long as you do not change the content in any way.  Click here to view a video that comprehensively describes EPSDT, BHRS and Defending the Civil Rights of Children with Disabilities.

The thread of MA eligibility has just been completed, tracing EPSDT “Behavioral Health Rehabilitation” (BHR) services through the U.S. Medicaid Law and the  Code of Federal Regulations.  Like an enormous bowl of spaghetti, the Medicaid statutes are witheringly complex and cross-referenced from here to Kingdom Come, defying anyone to “figure it all out.” In this 33 page document, I started with the first noodle in the bowl (the Social Security Act section 1902a) and followed it step-by-step, finding where it connects with other noodles relevant to BHR services.  I finally emerged from the bowl with a map showing how “Behavioral Health Rehabilitation” (BHR) services are part of the EPSDT mandate and how they can be implemented in other states in accordance with Medicaid regulations, just as they have been in Pennsylvania, where I have been implementing the equivalent of BHR services successfully since 1981 — more than 10 years before EPSDT officially came to Pennsylvania.  Contact me if you would like information about this work.

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