Adaptation: California’s Medicaid program has adopted the Bright Futures Guidelines as the standard of care in the state. In 2014, with the expansion of Medicaid, the state’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program updated its screening requirements and now requires the use of the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule.
California’s EPSDT program requires all Medi-Cal managed care plans (MCPs) to use questionnaires developed by the California Department of Health Care Services, the Staying Healthy Assessment Questionnaires, to assess health education areas that may be covered during visits. The state provides seven pediatric and two adult questionnaires for 0–6 months, 7–12 months, 1–2 years, 3–4 years, 5–8 years, 9–11 years, 12–17 years, adults, and seniors. The forms track whether the EPSDT provider offered anticipatory guidance, referrals, and/or follow-up on the health topics addressed during the visit. The topics include, but are not limited to, nutrition, physical activity, safety, dental health, mental health, alcohol/tobacco/drug use and exposure, and sexual health. The questionnaires are available to providers as downloadable PDF files in English, Arabic, Armenian, Chinese, Hmong, Korean, Russian, Spanish, Tagalog, and Vietnamese. In the near future, they will also be available as fillable PDF forms. California also allows MCPs to apply for approval to use alternative assessment questionnaires, such as the Bright Futures Previsit Questionnaires.
Implementation: California MCPs are required to conduct a Health Education and Cultural and Linguistic Group Needs Assessment to determine their members’ needs, local health disparities, available health education, available cultural and linguistic programs and resources, and gaps in services provided. Individual county/regional Health Education and Cultural and Linguistic Work Plans are developed from the demographic information and data from member surveys. The member surveys address the members’ need for interpreters, health topics of interest, preferred ways to learn about health, health education, and satisfaction with health information.
In 2014, California selected 9 pediatric preventive care measures to focus on. The quality measures are closely aligned to the Bright Futures Preventive Services Quality Improvement Measures and include childhood immunization status, immunization status for adolescents, well-child visits in the first 15 months, well-child visits between ages 3 and 6, adolescent well-child visits, preventive dental services, child and adolescent access to primary care providers, body mass index (BMI) assessment of children and adolescents, and chlamydia screening for women.
In addition, California’s Medicaid agency, in partnership with the state managed care organizations (MCOs), has selected various performance improvement projects to focus on specific to pediatric preventive care. Since 2014, California has focused specifically on BMI assessment of children and teens, postpartum depression screening, and, most recently, immunization of 2-year-olds. Within its MCOs, California uses various member and provider incentives, including pay for performance programs linked to the preventive care measures. As 90% of publicly insured children in the state are served through MCOs, California values the importance of consumer education and provides EPSDT materials for families in Armenian, Cambodian, Chinese, Farsi, Hmong, Korean Lao, Russian, Spanish, and Vietnamese.
Child Health and Disability Prevention: The Child Health and Disability Prevention (CHDP) program delivers periodic health assessments and services to low-income children and youth in California. Health assessments are provided by enrolled private physicians, local health departments, community clinics, MCPs, and some local school districts. Medi-Cal managed care providers must conduct all screenings required by CHDP; however, patients are required to be seen according to the CHDP Periodicity Schedule for Health Assessment Requirements by Age Groups. Since July 1, 2016, the CHDP program has required all Medi-Cal providers to use the Bright Futures/AAP Periodicity Schedule to determine the well-child health assessments schedule (CHDP Bright Futures Schedule for Health Assessments by Age Group and CHDP/EPSDT Periodicity Schedule for Dental Referral by Age). This policy added 14 reimbursable health assessments for children and youth from the ages of 1 to 20 years in the CHDP program.
The CHDP program offers the CHDP Dental Training
module to CHDP providers and county staff about oral health risk assessments and education, how to perform a dental assessment, preventive oral health services, and establishment of a dental home. The training module includes an introductory letter, trainer guide, the informational presentation, review questions, and printable educational materials for providers and families in various languages. The Bright Futures Guidelines has also been used by the state dental hygienist consultant. In conjunction with the Dental Subcommittee of the CHDP Executive Committee, continuous dental updates are given to providers, families, and local program staffs. The Bright Futures Oral Health guidelines have been aligned with the dental sections of the Health Assessment Guidelines. In addition, Bright Futures has been used as a basis for parent/family materials to encourage preventive care consistent with Bright Futures.