Almost all children enrolled in Head Start are eligible for Medicaid. Obesity and overweight are major health conditions affecting children enrolled in Head Start and their adult family members. Group nutritional counseling by dietitians is one approach for addressing and preventing obesity. Maryland Medicaid has undertaken a childhood obesity prevention strategy to facilitate the delivery of group nutritional counseling in Head Start settings by a licensed dietitian. Collaborative efforts are underway among a Maryland Medicaid managed care organization (MCO), the Maryland Academy of Nutrition and Dietetics and Head Start programs. Under a newly approved Medicaid billing code for group nutritional counseling, Medicaid MCO-participating dietitians can provide the service and be reimbursed by the child's MCO. This brief profiles how a state Medicaid agency and its partners can explore maximizing the authority that exists under federal Medicaid and Children's Health Insurance Program (CHIP) law to deliver an upstream preventive service in a nonclinical setting. Services for children provide an entry point for states desiring to move prevention upstream, given the robust scope of the federal Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children. Although the activities described here focus specifically on group nutritional counseling in Head Start settings in Maryland, key lessons and insights highlighted through the issue brief are relevant to other strategies that link traditional clinical preventive care to community-based settings to address chronic disease.
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