Alaska

In Alaska:
As of 2012, 96,693 individuals were eligible for EPSDT through Alaska’s Medicaid program. According to CMS data from 2012, Alaska achieved an EPSDT screening ratio of 49% and a participation ratio of 38%. 42,646 children received dental services of any kind, with 37,540 receiving preventive dental services.
Last updated June 2014.
Medical Necessity
Alaskan relies on the federal definition through state legislation defining EPSDT covered services as follows:
  • The department will pay for a service recommended as a result of the EPSDT screening, if that services is an authorized service under 42 U.S.C. 1396-1396w-1.
  • The department will pay for the following additional services for children under 21 years of age if the screening identifies a need for that service:
    • podiatry services under 7 AAC 110.500 – 7 AAC 110.505;
    • nutrition services under 7 AAC 110.275;
    • private-duty nursing services under 7 AAC 110.520 – 7 AAC 110.535;
    • hospice care under 7 AAC 140.280.
Initiatives to Improve Access
Alaska is part of the Tri-State Child Health Improvement Consortium (T-CHIC), in which it is collaborating with Oregon and West Virginia as part of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Project. Through this project Alaska is working to develop medical homes for children enrolled in Alaska Medicaid and Denali Kid Care as a way to increase access to EPSDT services.
Reporting & Data Collection
As part of Tri-State Child Health Improvement Consortium (T-CHIC), Alaska is requiring successful medical home pilots to address the following areas:
  • Developing, adopting and implementing quality measurement tools;
  • Developing, adopting and/or improving Health Information Technology, Electronic Health Records (EHR), and participation in Health Information Exchanges (HIE); and
  • Developing, adopting and/or improving medical home approaches
The participating medical homes also must comply with the CHIPRA Core Measures for voluntary use by Medicaid and CHIP programs.
Behavioral Health
Behavioral and mental health services are covered on a fee-for-service basis as deemed medically necessary.
As described in Alaska’s Integrated Behavioral Health Regulations, Medicaid-covered behavioral health services for children include therapeutic behavioral health services and day treatment services for children.
The state’s EPSDT provider billing manual encourages developmental screenings and assessments. The Alaska Department of Health and Social Services recommends a number of developmental screening tools, including the Ages and Stages Questionnaire, the Battelle Developmental Inventory Screening Tool, and Parents’ Evaluation of Developmental Status.
Support to Providers and Families
Support to Families
Alaska relies on mailings and newsletters to inform families about the EPSDT benefit.
Support to Providers
Alaska contracts with Xerox State Healthcare LLC, which maintains the Alaska Medical Assistance Health Enterprise Portal to support providers.
Care Coordination
Alaska, through its contractor Qualis Health, provides case management services designed for patients with serious illness, injuries, and some chronic conditions. These services are available to children with disabilities and children covered by Alaska’s Children with Complex Medical Conditions Waiver. Upon receiving a referral for case management services, a Qualis Health nurse manager works with the patient and family on a number of things related to health care needs including working with the patient, family and medical providers to develop a coordinated care plan. Additionally, these managers also help coordinate the services provided by all professionals involved.
The coordination of EPSDT services – including dental, behavioral, and other need – for Medicaid children is also a primary goal of the practices participating in the T-CHIC initiative.
Oral Health
Alaska Medicaid covers all dental services for children on a fee-for-service basis. This includes exams, X-rays, scaling, polishing, sealants, and fluoride varnish (physicians may apply fluoride varnish in Alaska). Alaska also covers dentures, crowns, caps, root canals and oral surgery, though some may require prior authorization. Alaska also covers orthodontia services, including braces, if deemed medically necessary and prior authorization is obtained.