More than twice the number of states now cover maternal depression screenings in Medicaid well child visits, up to 25 states from 11 states just one year ago. This is good news for mothers and children, and comes from an update of the National Center for Children in Poverty’s two-generation state policy profiles.
The profiles are chock full of other helpful information about state parent-child policies, such as state Medicaid eligibility levels for parents and children, adult-to-child ratios in child care settings and Medicaid coverage for family planning to otherwise ineligible low-income women, but here we’ll focus on reimbursing maternal depression screenings through a child’s Medicaid coverage.
Screening mothers for depression as part of a child’s well visit recognizes the close link between maternal wellbeing and healthy child development. Moms experiencing depression have a harder time bonding with their children, and a report from the American Academy of Pediatrics found that children living with mothers with depression may “…show impaired social interactions and delays in development.”
Additionally, moms with lower incomes are more likely to experience depression than moms with higher incomes. Between 40 and 60 percent of low-income women report experiencing some depressive symptoms, compared with 5-25 percent of all pregnant, post-partum and parenting women, the AAP report found. These disparities make it all the more critical that Medicaid, which covers low-income children and adults, reimburse pediatric providers for performing maternal depression screening.
The significant increase in the number of states covering the screening is encouraging, and likely attributable to guidance that CMS produced in 2016 outlining how and why states should include maternal depression screening in well child visits, and how to make the case that the treatment is medically necessary for the child under EPSDT.
The guidance clarifies that, “…since the maternal depression screening is for the direct benefit of the child, state Medicaid agencies may allow screenings to be claimed as a service for the child as part of the EPSDT benefit.”
And because the screening is part of the EPSDT benefit, follow-up treatment for any diagnosis is required. If the family lives in an expansion state, the treatment can be directly billed to the mother’s Medicaid coverage. In a non-expansion state where the mother doesn’t have coverage, the treatment must actively involve the child, and can include family therapy or Medicaid-reimbursable home visiting.
For instance, Texas lawmakers passed a bill in 2017 to screen new mothers for postpartum depression when they take their babies to well child visits covered by Medicaid and CHIP. This was spurred by several reports of a disturbing spike in pregnancy-related deaths in Texas (a non-Medicaid expansion state), and findings by the state’s Maternal Morbidity and Mortality Task Force that mental health and behavioral disorders play a large role in the rise in maternal death in the state. Starting this July, mothers can be screened at any well visit before the child’s first birthday, and physicians must share positive screening results and develop a referral plan with the mother.
Adding maternal depression screenings to well child visits is a concrete way to further integrate two-generation mental health approaches to improve the healthy development of children and families. We hope to see even more states covering the screenings in next year’s report!