The 1967 Amendments to Title XIX of the Social Security Act (which includes Medicaid guide- lines) directed states with Medi- caid programs to implement the Early and Periodic Screening, D iagnos i s a n d T r e a t m e n t (EPSDT) program. EPSDT was designed to equalize access to health care in the United States for children from low income households, particularly in rural and inner city areas. Ten years later, many Medicaid eligible children were still not being served. To eliminate this short- coming, the U.S. Office of Education and the Health Care Financing Administration jointly recommended that access to EPSDT services be provided th rough schools wherever feasible. 1.2

Beginning with the 1980-81 school year, two Texas school districts, Dallas and San Antonio, piloted EPSDT pro- grams. Participation was pre- dicated upon the anticipated benefits t o school children, particularly those entering school for the first time - specifically, the identification and removal of health barriers to learning. The school districts received $30 from

EPSDT in Texas Schools Gladys Baker Carol C. Gray Gene McGovern Jerry Newton

Medicaid for each student screen- ed. The two programs encounter- ed similar successes and obstacles and reached similar conclusions: I. Successes

A. Parents were pleased that additional needs of their children were being defined and at least partially met in the school setting.

B. Students screened at school were absent from classes for shorter periods of time than those screened at other sites.

C. Most students identified in the schools as Medicaid-EPSDT eligible were screened.

D. Screenings performed by the school nurse practitioners (SNPs) supervised by pediatri- cians were t h o r o ~ g h . ~ (SNPs were competent and trained in recog- nizing medical, mental, and developmental problems in chil- dren.)

E. Health history and physical assessment resulted in identifying significant health problems. Many of the problems were amenable to therapeutic inter- vention. Identified problems were referred to appropriate medical, social or educational specialists.

F. There was a high per- centage of completed referrals. The primary screeners and the school nurses facilitated the follow-up process.

G . School adminis t ra tors valued the additional medical, e d u c a t i o n a l a n d soc ia l information that aided in formulating educational plans for children with problems. 11. Obstacles

A . Iden t i fy ing Medica id eligible students enrolled in the school was a major problem and never entirely resolved. (Official lists of Medicaid recipients by school attendance zone did not exist).

B. The programs were not entirely cost effective when dol- lars reimbursed and number of children screened were the sole criteria considered. (There were also hidden costs for outreach and follow-up).

C . Some parents expressed the wish that treatment (in addition to screening) could be instituted at school.

The EPSDT programs in public schools in Dallas and San Antonio are continuing through- out the 1981-82 school year with

262 THE JOURNAL OF SCHOOL HEALTH APRIL 1982

the knowledge that they are not fully "paying their way" at this time. Once the hurdle of identifi- cation (Medicaid eligibles) is cleared, it may still be possible for a nurse practitioner to gener- ate most or all of her salary in a well organized program.

It is hoped that the health and educational benefits the pro- grams provide for students will reimburse school systems in addi- tional ways in the future. This may be in the form of decreased health-related absences from school or in the improvement of the quality of life and future pro- ductivity of students. It is hoped that programs from Texas, Louisiana and other states will be carefully evaluated and the find- ings incorporated into future

planning by the Department of Health and Human Services.

References 1 . Position statement on Access to

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services Through Schools. Federal Register -44(194): 57065-57378, October 4, 1979.

2. Adam RM: EPSDT-Can Schools Save the Faltering Giant? J Sch Healfh 50(8):484, 1980.

Carol C. Gray, MD, Director- EPSDT Screening, Gladys Baker, RN, NP, Gene McGovern, RN, PNP, Dallas Independent School District, 3 700 Ross A ve., Dallas, TX 75204; Jerry Newton, MD, Director-School Health Services, San Antonio Independent School District, 141 Lavaca St . , San Antonio, TX 78210.

support March of Dimes

THIS SPACE CONTRIBUTED BY THE PUBLISHER

82.4

I i I I I I I I I I I I I I I I I I I I I I I I I I I I I I

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APRIL 1982 THE JOURNAL OF SCHOOL HEALTH 263