General and Behavioral Health Screening Under EPSDT for Adolescents in New York Medicaid Managed Care.

Importance: Medicaid-enrolled children are entitled to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits, which include general and behavioral health (BH) screenings. Adolescents remain among the least likely to receive recommended screenings, and little is known about how screening delivery varies across plans or aligns with plan quality ratings. Objectives: To examine trends in general and BH screenings under EPSDT among adolescents aged 12 to 18 years in New York Medicaid managed care and to assess whether screening performance differs by managed care organization (MCO) quality ratings. Design, Setting, and Participants: This cross-sectional study used New York Medicaid administrative data from January 2016 to December 2021, including enrollment and claims from the Transformed Medicaid Statistical Information System analytic files. During the study period, reporting of BH screening was voluntary. The study included adolescents aged 12 to 18 years who were continuously enrolled for at least 6 months in a given calendar year. Data analysis was conducted from March 2025 to January 2026. Exposure: Enrollment as an adolescent in a Medicaid MCO in New York State. Main Outcomes and Measures: Claims-based measures of utilization of general and BH screenings consistent with EPSDT services. The primary measures were (1) the percentage of adolescents receiving at least 1 general screening and (2) the percentage receiving at least 1 BH screening during a calendar year. In a supplemental analysis, the correlation between general and BH EPSDT screening rates was tested. Results: This cross-sectional study included 1 562 342 unique adolescents aged 12 to 18 years enrolled in New York Medicaid from 2016 to 2021 (mean [SD] age, 14.9 [2.0] years; 761 203 [48.7%] female; 7629 [0.5%] American Indian or Alaska Native; 148 576 [9.5%] Asian American or Pacific Islander; 286 003 [18.3%] Black; 204 340 [13.1%] Hispanic; 403 490 [25.8%] White; 512 304 [32.8%] additional groups or missing information). General EPSDT screening rates ranged from 52.5% to 61.0% annually, with the lowest rate observed in 2020 during the onset of the COVID-19 pandemic. BH screening rates increased over time, from 7.7% in 2016 to 21.2% in 2021, but remained substantially lower than general EPSDT screening rates, reaching only about one-third of general screening rates. Screening rates were highest for mid-adolescents (ages 14-16 years) and lowest for ages 12 and 18 years. Across MCOs, general screening rates were relatively consistent, whereas BH screening rates varied widely, with only moderate correlation between the 2 screening types at the plan level (Pearson r = 0.47). BH performance showed little alignment with state-assigned MCO quality ratings. Conclusions and Relevance: In this cross-sectional study of adolescents in New York Medicaid from 2016 to 2021, BH screening rates remained far lower than general EPSDT screening rates, with wide variation across MCOs and limited alignment with state-assigned MCO quality ratings. These gaps may reflect long-standing structural challenges, including previously voluntary reporting of adolescent depression screening by the Centers for Medicare & Medicaid Services under the Mandatory Core Set of Behavioral Health Measures for Medicaid and Children's Health Insurance Program. Incorporating now-mandatory BH measures into MCO performance benchmarks could increase adolescent BH screening rates, strengthen accountability, support earlier detection of mental health conditions, and reduce variation in preventive care delivery both in New York and nationwide.