New CMS Guidance Highlights Policy Options for Screening and Treating Maternal Depression
By Stephanie Schmit and Christina Walker
The U.S. Centers for Medicare and Medicaid Services (CMS) havereleased an Informational Bulletin (IB) highlighting the critical role Medicaid can play in supporting state policy choices to promote young children’s healthy development through maternal depression screening and treatment.
The guidance in the IB clarifies that states can allow maternal depression screenings to be claimed as a service for the child under Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit, because the scientific evidence indicates that maternal depression is a risk factor for the child and that screening in a well-child visit is a best practice. Once a state makes that choice, providers such as pediatricians can be reimbursed for conducting the screening. After diagnosis, the guidance also clarifies that treatment services provided to the mother and child together—for example, family or dyadic therapy (but not separate treatment for the mother alone)—can also be claimed as direct services for the child.
This guidance is highly significant for families in all states, both those that have chosen to expand Medicaid and those that have not. States that have not expanded Medicaid coverage for parents now have clear guidance indicating that providers can be reimbursed for screening and for joint mother-child treatment, even when the mother is not eligible for Medicaid. The ability to reimburse the screening as part of EPSDT may be especially important in states that have not expanded Medicaid because mothers without insurance may not encounter a medical professional other than their child’s pediatrician. In these states, the screening will likely identify many mothers who need treatment for their depression yet are not eligible for Medicaid as a resource to support that treatment. For mothers who are not eligible for Medicaid themselves and are uninsured, the ability to receive reimbursable treatment when provided jointly with their child opens up new possibilities for treating maternal depression for low-income women. On the other hand, states that have expanded Medicaid coverage will be able to take advantage of the two specific options clarified in the guidance while also reimbursing for the mother’s own needed treatment under her Medicaid coverage.
The IB identifies important policy opportunities that all states should seize. Untreated maternal depression, particularly in mothers of young children, is a major public health problem that can interfere with parents’ capacity to help children develop, place children’s safety and cognitive and emotional development at risk, and stymy families’ efforts to escape poverty. Even though research shows that effective treatments can reduce maternal depression and its negative consequences, low-income mothers of young children have very high rates of untreated depression—for reasons that include the high costs of mental health care in the absence of Medicaid or other insurance coverage.
This guidance is particularly timely as it follows on the heels of recent actions by the United States Preventive Services Task Force (USPSTF), which called for universal depression screening and treatment for all adults, including pregnant and postpartum mothers. The USPTF recommendation raised the visibility of depression screening as a crucial public health service and created financial incentives for state Medicaid programs to provide coverage. As outlined in a recent joint letter to the editor of the New York Times from CLASP and the National Center for Children in Poverty, the USPTF action should provide a catalyst for states to go beyond screening alone to seize new opportunities in the Affordable Care Act (ACA) to treat maternal depression. This guidance offers states clear options in taking these critical next steps.
We urge state advocates and leaders to seize the opportunity provided by this IB—as well as the USPTF action and other recent guidance about Medicaid and home visiting—to bring together key stakeholders who care about low-income children and families and create a systematic approach to identifying and treating mothers’ depression. In addition, CLASP will soon be releasing a brief to help state early childhood, anti-poverty, mental health, and Medicaid leaders work together to take advantage of this and other opportunities under the ACA to make large-scale progress on identifying and treating mothers with depression—thus improving the lives and prospects of young children and their families’ economic stability.