Scope of Health Care Benefits for Neonates, Infants, Children, Adolescents, and Young Adults Through Age 26

Timely access to appropriate health care from the prenatal period onward is one of several pillars essential to optimize the health of a child preparing to become an adult. In 1967, Congress passed legislation that specified an Early and Periodic Screening, Diagnostic and Treatment standard as the mandatory child health component of Medicaid. Subsequent legislative amendments have generally strengthened this standard. In particular, state Medicaid programs must provide any health care service for children that is covered by the federal Medicaid program even if the state does not cover that service for adults. An initial set of detailed recommendations concerning the best preventive care services for children, adolescents, and young adults was published in 1994 based on deliberations of a large group of expert pediatric health care providers and family representatives. The most recent updated recommendations are available in the 2017 fourth edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. The Patient Protection and Affordable Care Act of 2010 (Pub L No. 114-148) referenced Bright Futures recommendations as a standard for access to and design of age-appropriate health insurance benefits for neonates, infants, children, adolescents, and young adults. This policy statement summarizes recent developments pertaining to the scope of health care benefits offered for children by public and private payers. The statement identifies barriers that impede achievement of a uniform standard that all payers can adopt. Finally, the statement refreshes a recommended set of health insurance benefits for neonates, infants, children, adolescents, and young adults through age 26.

Automated summary

Timely access to appropriate health care from the prenatal period onward is crucial for optimizing the health of children and facilitating their transition into adulthood. Legislation passed in 1967 established a standard for early and periodic screening, diagnostic, and treatment services for children enrolled in Medicaid.