Vermont’s Coordinated Approach to Medicaid Reimbursed Development Screening

The following blog post is the second in our series celebrating the Week of the Young Child (#WOYC18).


Improving child development screening is an important goal for early care and education (ECE) providers, as well as pediatricians and other primary care practitioners. Vermont has found a way to coordinate the efforts of both and streamline the process for families as well. In Vermont, many ECE providers have been trained to conduct the screenings, and pediatric practitioners interpret and discuss the results with families, and then work with them to create a plan to address any needs that may have been identified. Medicaid will reimburse the pediatric practitioner for these activities. If a child does not receive a screen in an ECE, pediatricians proceed with screen according to Bright Futures guidelines.



Dr. Breena Holmes, Maternal and Child Health Director for the Vermont Department of Health, explained that Vermont’s coordinated approach is enhanced by the state’s Universal Developmental Screening Registry. Through this online registry, registered ECE screening organizations can input results from the Ages and Stages Questionnaire-3 (ASQ-3) and the Modified Checklist for Autism in Toddlers (M-CHAT) screening tools. Doctors can then easily access the system, search for the child’s record and review the results with families. To further improve the system, the Vermont Child Health Improvement Program (VCHIP) offers comprehensive quality improvement trainings to medical homes serving children and ECE programs. Not only does this training improve developmental screening practices and referrals, it brings together and builds trust among health and childcare professionals who are working on behalf on the same children and families.

Vermont’s strategy built upon a similar approach being used in Oregon, in which families have to bring the child’s screening results to the pediatrician for review. The advent of the screening registry made this intermediary step unnecessary. Jamie Colvard, Senior Technical Assistance Specialist with ZERO TO THREE, which provided technical assistance to both states to help them identify and take action on cross-sector infant-toddler policy priorities, is pleased to see Vermont’s innovation. “It’s very helpful for states to think about how they can coordinate the screening, referral and follow-up that’s happening in various settings,” Colvard said. “You want to make it as seamless as possible for parents.”

Developmental screening is a critical tool to improve outcomes for children by detecting risks for early developmental delays. While the American Academy of Pediatrics recommends that developmental monitoring should be a part of every well-child preventive care visit, a 2009 studyreported that less than 50% of surveyed pediatricians reported using formal developmental screening tools. Primary healthcare providers cite several challenges to implementing regular use of screening tools, including inadequate compensation, ambiguity around Medicaid billing rules, time (during well child visits) and insufficient training. Vermont’s approach addresses several of these barriers.

Dr. Holmes suggests that states reach out to Early Childhood partners, including Head Start and to state Medicaid colleagues to discuss how developmental screening processes can be improved. She also pointed out that both Oregon and Vermont’s innovative approaches have been implemented through Help Me Grow affiliates – and they could be valuable partners in implementing it in other states as well. Additional developmental screening resources are available on this resource list from ZERO TO THREE.

Selena Chavez is a program and research assistant at CSSP.