Rachel Rosales, MPH, discusses how to close the gap in behavioral health screening

In an interview with Contemporary Pediatrics, Rachel Rosales, MPH, doctoral candidate at Brown University School of Public Health, discussed the significant disparities in behavioral health (BH) screening compared with general physical health screenings under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

Even at their peak in 2021, BH screening rates were only approximately one-third of general EPSDT screening rates. Rosales attributed this gap to structural and operational barriers. Structurally, general screenings are deeply embedded in pediatric workflows and tied to quality metrics, whereas BH screenings have historically been voluntary under the Centers for Medicare and Medicaid Services’ (CMS) Core Set of Behavioral Health Measures. Operationally, practices often face extreme time constraints and a lack of embedded BH capacity, making providers hesitant to screen if they feel unequipped to handle a positive result.

CMS recently shifted adolescent depression screening from voluntary to mandatory. Rosales believes this mandate is a critical "first step" because measurement typically drives behavior among health plans and providers. This shift is expected to:

• Encourage standardization across managed care organizations (MCOs)
• Identify underperforming plans
• Create incentives for providers to prioritize mental health

However, she emphasized that measurement alone is insufficient; it must be paired with delivery system supports, such as referral networks and care coordination.

To hold MCOs accountable, Rosales suggested that states incorporate specific BH benchmarks into their quality rating systems, including the following:

• Annual screening rates using validated tools
• Follow-up protocols after a positive screen
• Connection to treatment within defined time frames

The data revealed surprising dips in screening at ages 12 and 18 years. These correlate with major life transitions, such as moving to middle school at 12 years and aging out of pediatric care or relocating for college at 18 years. Rosales recommended strengthening transition-of-care protocols and ensuring BH screenings are a standard part of visits starting in early adolescence.

Rosales concluded that integrated care models—embedding BH specialists directly into pediatric practices—are essential for closing these gaps. When specialists are on-site, screening becomes more actionable, reducing treatment delays and making care more accessible for Medicaid-enrolled families in a familiar setting.

Reference

Rosales R, Meyers DJ, McConnell KJ, et al. General and behavioral health screening under EPSDT for adolescents in New York Medicaid managed care. JAMA Netw Open. 2026;9(3):e263060. doi:10.1001/jamanetworkopen.2026.3060