DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
CMCS Informational Bulletin 
 
DATE:  May 11, 2016 
 
FROM:  Vikki Wachino, Director                                                                                       
Center for Medicaid and CHIP Services 
SUBJECT:  Maternal Depression Screening and Treatment: A Critical Role for Medicaid 
in the Care of Mothers and Children 
Introduction 
This Informational Bulletin discusses the importance of early screening for maternal depression 
and clarifies the pivotal role Medicaid can play in identifying children with mothers who 
experience depression and its consequences, and connecting mothers and children to the help 
they need.  State Medicaid agencies may cover maternal depression screening as part of a well-
child visit.  In addition, states must cover any medically necessary treatment for the child as part 
of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.   
Prevalence and Impact of Maternal Depression 
Maternal depression is a serious and widespread condition that not only affects the mother, but 
may have a lasting, detrimental impact on the childs health.  Maternal depression presents a 
significant early risk to proper child development, the mother-infant bond, and the family. 
Maternal depression screening and treatment is an important tool to protect the child from the 
potential adverse physical and developmental effects of maternal depression.  According to the 
American Academy of Pediatrics (AAP), screening mothers for maternal depression is a best 
practice for primary care pediatricians caring for infants and their families1 and can be integrated 
into the well-child care schedule, as well as included in the prenatal visit.  
Maternal depression is characterized by a spectrum of severity: the common maternity blues or 
baby blues are usually gone after a few days or one to two weeks and are helped with 
reassurance and support for the mother.  This is distinct from postpartum depression and post-
partum psychosis (the most serious condition), which meet specific diagnostic criteria.2  
According to AAP, it has been estimated that 5 percent to 25 percent of all pregnant, postpartum 
and parenting women have some type of depression depending on the population surveyed.  
Maternal depression in this guidance encompasses the full spectrum of severity, not only the 
most severe diagnoses.  Mothers who have low incomes are more likely to experience some form 
of depression than the general population of mothers.  For low-income women, rates of 
depressive symptoms are reported to be between 40 percent and 60 percent.3  There are estimates 
that 11 percent of infants in families with incomes below the federal poverty level live with a 
mother who has severe depression and that more than half (55 percent) of all infants living in 
poverty are being raised by mothers with some form of depression.4  
In light of recent evidence that children living with mothers with depression may be at risk for 
long-term physical and behavioral health consequences, the importance of screening and treating  CMCS Informational Bulletin - Page 2  
maternal depression is clear.  As Harvard Universitys Center on the Developing Child indicated 
in 2009, children raised by a clinically depressed mothers may perform lower on cognitive, 
emotional, and behavioral assessments than children of non-depressed caregivers, and are at risk 
for later mental health problems, social adjustment difficulties, and difficulties in school.5  The 
risk to the child may depend on the severity of the maternal depression, but timely screening and 
appropriate treatment can reduce maternal depression and its consequences.   
According to the AAP, If the maternal depression persists untreated and there is not 
intervention for the mother and the dyadic relationship, the developmental issues for the infant 
also persist and are likely to be less responsive to intervention over time. 6  Recent research 
shows promising results for intensive interventions that focus specifically on mother-child 
interactions, suggesting that treatments designed to improve child well-being must attend both to 
relieving the mothers depression and focus on interactions with the child as central dimensions 
of the interventions. 7 
Medicaids Role in Maternal Depression Screening and Treatment  
Screening 
Maternal depression screening is endorsed by several independent expert medical panels that 
impact services provided to Medicaid eligible children and adults.  For example:   
The AAP-endorsed Bright Futures: Guidelines for Health Supervision of Infants, Children and 
Adolescents TM is used by many states to implement their EPSDT well-child visits.  Bright 
Futures includes recommendations for well-child visits at one week and one and two months of 
age, including a recommendation for Parental (maternal) well-being, which includes a 
postpartum checkup, with depression and substance abuse screening.  Any suggestion of 
depression should trigger screening questions and providers furnishing these services as part of a 
well-child visit are guided to refer the mother to her obstetrician or other health care professional 
and appropriate community-based mental health services.  In terms of Medicaid coverage, 
covering Bright Futures recommended services as part of the preventive benefit strengthens 
access to these services.   
In addition, the United States Preventive Services Task Force (USPSTF) recently published 
recommendations for screening for depression in the general adult population, including 
pregnant and postpartum women. 8  The recommendation was given a B grade, based on the 
quality and strength of the evidence about potential benefits and harm for screening for this 
purpose.  For state Medicaid agencies, section 4106 of the Affordable Care Act (ACA) 
established a one percentage point increase in the Medicaid federal medical assistance 
percentage (FMAP) applied to expenditures for preventive services to states that cover all 
USPSTF grade A and B preventive services and the Advisory Committee on Immunization 
Practices (ACIP) recommended vaccines.   
The EPSDT benefit is Medicaids comprehensive child health benefit.  Under the EPSDT 
benefit, eligible individuals under age 21 must be provided periodic screening services (well 
child exams).9  One required element of this screening is a comprehensive health and 
developmental history, including assessment of physical and mental health development.   CMCS Informational Bulletin - Page 3  
A maternal depression screening can be considered an integral part of a risk assessment for the 
child, in light of the evidence that maternal depression can place children at risk of adverse 
health consequences.  There are several validated screening tools for depression which are 
simple to administer and can help identify maternal depression and potential risk to the child.10  
Some of these screening tools are specific to postpartum women and some are more general. 
Some states cover maternal depression screening as part of a Medicaid well-child visit.  These 
states may instruct providers to claim for this activity either as a service for the child or for the 
mother, depending on the mothers Medicaid eligibility.  The Centers for Medicare & Medicaid 
Services (CMS) wishes to clarify that, since the maternal depression screening is for the direct 
benefit of the child, state Medicaid agencies may allow such screenings to be claimed as a 
service for the child as part of the EPSDT benefit.  State Medicaid agencies have discretion to 
determine reimbursement approaches available to the pediatric provider for furnishing the 
maternal depression screening.   
In keeping with the expert recommendations, several state Medicaid agencies have recognized 
the importance of the maternal depression screening and are allowing providers to perform and 
bill for this screening as part of the EPSDT well-child visit: 
  Colorado: The Colorado Department of Health Care Policy and Financing issued 
Provider Bulletins with guidance on maternal depression screening.  Starting January 
2014, postpartum depression screening is covered as an annual depression screening and 
Medicaid primary care providers are encouraged to screen new mothers at a well-child 
visit using the mothers Medicaid ID number.  To facilitate screening in more settings, 
providers seeing an infant for a well-baby visit are alternatively allowed to bill for the 
service using the Medicaid ID of the infant.11 
  Illinois: The Illinois Department of Healthcare and Family Services (HFS) covers 
perinatal depression screening when an approved screening instrument is used.  If the 
postpartum depression screening (for the woman) occurs during a well-child visit or 
episodic visit for an infant (under age one) covered by HFS Medical Programs, the 
screening may be billed as a "risk assessment" under the infants Medicaid identification 
number.  Alternatively, if the woman is postpartum and covered by HFS Medical 
Programs, the postpartum depression screening may be billed under the woman's 
identification number.12 
  North Dakota: North Dakota Medicaid covers maternal depression screening as a 
separate service when performed in conjunction with a Health Tracks (EPSDT) screening 
or any other pediatric visit, and is considered a risk assessment for the child.  Up to three 
maternal depression screenings are allowed for a child under the age of one.  Providers 
are instructed to bill only when one of the standardized screening tools is used and to bill 
using the childs North Dakota Medicaid ID Number.13 
  Virginia: Virginia covers the Behavioral Health Risks Screening Tool developed for 
pregnant and non-pregnant women of child-bearing age through the Maternal, Infant, and 
Early Childhood Home Visiting Program.  The state provided information to practitioners 
on how to bill Medicaid for using the screening tool as well as what treatment services 
are available to women who screen positive.  The Edinburgh Postnatal Depression 
Anxiety Subscale is used to address depressive symptoms and risk of co-occurring 
anxiety.  Pregnant women are eligible for additional services, including case management  CMCS Informational Bulletin - Page 4  
during pregnancy and up to the end of the month following their 60th day post-partum.  
Infants are eligible for case management services up to their second birthday.14 
 
Diagnostic and Treatment Services 
If a problem is identified as a result of an EPSDT screen, states have an obligation to arrange for 
medically necessary diagnostic and treatment services to address the childs needs.15  Diagnostic 
and treatment services directed solely at the mother would be coverable under the Medicaid 
program only if the mother is Medicaid eligible.  Mothers who are not Medicaid eligible may 
receive some benefit from diagnostic and treatment services directed at treating the health and 
well-being of the child (such as family therapy services) to reduce or treat the effects of the 
mothers condition on the child.  Consistent with current policy regarding services provided for 
the direct benefit of the child, such diagnostic and treatment services must actively involve the 
child, be directly related to the needs of the child and such treatment must be delivered to the 
child and mother together, but can be claimed as a direct service for the child.  Such services also 
must be coverable under one or more section 1905(a) benefit categories such as rehabilitative 
services or other licensed practitioner services.    
 
State Medicaid agencies should encourage the childs provider to refer mothers for other 
appropriate care, including diagnosis, therapy and/or medication.  Mothers who are Medicaid 
eligible should be referred to their primary care providers or other appropriate providers.  
Mothers who are ineligible for Medicaid, or lose their eligibility 60 days postpartum, can be 
referred to community resources that offer appropriate mental health services, such as 
community mental health programs, federally qualified health centers or other programs that 
may exist in the community. For example, the Substance Abuse and Mental Health Services 
Administration (SAMHSA) offers a behavioral health treatment service locater at 
https://findtreatment.samhsa.gov/.  Eligibility levels for parents in state Medicaid programs vary; 
in states that have taken up Medicaids expansion of eligibility to low income adults, 
significantly greater number of low income mothers will be eligible and can receive 
comprehensive coverage than in states that have not.   
 
The Health Resources and Services Administration (HRSA) in partnership with the 
Administration for Children and Families (ACF), funds states, territories and tribal entities to 
create home visiting evidence-based programs that improve maternal and child health, prevent 
child abuse and neglect, encourage positive parenting, and promote child development and 
school readiness.  Medicaid coverage authorities offer states the flexibility to provide services in 
the home, which may improve care and service delivery for eligible pregnant women, parents, 
and young children.  The majority of evidenced-based home visiting programs deliver services 
such as screening, case management, family support, counseling, and skills training for pregnant 
women and parents with young children and many of these services are also Medicaid-coverable. 
CMS issued an Information bulletin on March 2, 2016 describing the intersection between home 
visiting models and Medicaid16.   
 
Promoting Maternal Depression Screening Under Medicaid 
 
Generally, experience in states has shown that there is broad agreement that communication to 
providers about screening tools, Medicaid billing codes, referral options and other information is  CMCS Informational Bulletin - Page 5  
central for successful uptake and continued use.17  States and managed care plans use a variety of 
approaches to promote maternal depression screening among providers, including: 
 
  Posting information about maternal depression screening on provider websites and 
publishing information in provider newsletters. 
  Delivering provider trainings to promote the use of maternal depression screening tools 
and proper billing codes. 
  Conducting in-person visits to clinics to train providers on how to implement screenings, 
help practices modify clinic flow, and discuss referral strategies. 
  Offering practitioners continuing medical education (CME) credits for participation. 
 
States that elect to cover this service utilizing a managed care delivery system must ensure that 
the service is appropriately reflected in the managed care plans contract, and can include 
performance standards to ensure that the service is widely performed.  Activities designed to 
promote maternal depression screenings among Medicaid providers and to train them on how to 
incorporate maternal depression screening and treatment into the EPSDT well-child visit are 
generally eligible for Medicaid administrative matching funds.  
Conclusion 
Maternal depression can take a substantial toll on the health and well-being of both mothers and 
children, and can increase related health costs, impede the development of the child, and create 
negative social consequences.  Maternal depression screening during the well-child visit is 
considered a pediatric best practice and is a simple way to identify mothers who may be 
suffering from depression and may lead to treatment for the child or referral for mothers to other 
appropriate treatment.  In addition to covering this screening for Medicaid eligible mothers, 
states may cover maternal depression screening for non-Medicaid eligible mothers during the 
well-child visit.  States may also cover treatment for the mother when both the child and the 
mother are present, treatment focuses on the effects of the mothers condition on the child, and 
services are for the direct benefit of the child.     
States interested in learning more on this topic and to request technical assistance may contact 
Kirsten Jensen, Director, Division of Benefits and Coverage at Kirsten.jensen2@cms.hhs.gov.   
                                                           
Endnotes 
 
1 Managing Maternal Depression Before and After Birth, American Academy of Pediatrics, 
October 25, 2010 Managing Maternal Depression Before and After Birth, American Academy of 
Pediatrics, October 25, 2010  http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2348v1 
2 Earls, Marian, MD. Clinical Report  Incorporating Recognition and Management of Perinatal 
and Postpartum Depression into Pediatric Practice, American Academy of Pediatrics, 2010 
http://pediatrics.aappublications.org/content/early/2010/10/25/peds.2010-2348 
3 Earls, 2010 
4 Veriker, Tracey, Jennifer Macomber, and Olivia Golden, Infants of Depressed Mothers Living 
in Poverty: Opportunities to Identify and Serve, The Urban Institute. August 2010 
5 Maternal Depression Can Undermine the Development of Young Children, Working Paper 8, Center on the 
Developing Child, Harvard University, December 2009.  http://www.developingchild.harvard.edu.    CMCS Informational Bulletin - Page 6  
                                                                                                                                                                                           
6 Earls, 2010  
7 Center on the Developing Child, Harvard University, December 2009   
8http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal
/depression-in-adults-screening1#discussion1  
9 Section 1905(r) of the Social Security Act.   
10 Identifying and Treating Maternal Depression: Strategies and Considerations for Health 
Plans, National Institute for Health Care Management Foundation, June 2010.  See Table 4.  
 http://www.nihcm.org/pdf/FINAL_MaternalDepression6-7.pdf  Tools like the Edinburgh 
Postpartum Depression Scale and Postpartum Depression Screening Scale have been developed 
specifically to measure postpartum depression. As part of their recommendation to screen adults 
for depression in primary care settings, the USPSTF concluded that asking two simple questions, 
such as those included in the Patient Health Questionnaire-2, may be as effective as more formal 
instruments. 
11 Colorado Department of Health care Policy and Financing, Provider Bulletins:  Postpartum 
Depression Screenings and Payment in the Pediatric Primary Care Office (March 2014) and 
Supplement (August 2014). 
12 Handbook for Providers of Healthy Kids Services: Policies and Procedures for Healthcare for 
Children, Illinois Department of Healthcare and Family Services, January 2015. 
http://hfs.illinois.gov/html/010915n.html 
13 North Dakota Department of Human Services, Medical Services Division, Medicaid Coding 
Guideline, effective July 1, 2011, revised June 11, 2013. https://www.nd.gov/dhs 
14 Reimbursement Efforts to Address Depression Among Pregnant and Postpartum Women, 
Colorado Department of Public Health and the Environment, November 2013. 
https://www.colorado.gov/pacific/sites/default/files/PF_Reimbursement-Efforts-to-Address-
Depression-Among-Pregnant-and-Postpartum-Women.pdf 
15 EPSDT  A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents, 
Center for Medicaid and CHIP Services, CMS, June 2014 https://www.medicaid.gov/medicaid-
chip-program-information/by-topics/benefits/downloads/epsdt_coverage_guide.pdf 
16 Coverage of Maternal, Infant, and Early Childhood Home Visiting Services. Center for 
Medicaid and CHIP Services, CMS, March 2016. https://www.medicaid.gov/federal-policy-
guidance/downloads/CIB-03-02-16.pdf 
17 Reimbursement Efforts to Address Depression Among Pregnant and Postpartum Women, 
Colorado Department of Public Health and the Environment, November 2013. 
https://www.colorado.gov/pacific/sites/default/files/PF_Reimbursement-Efforts-to-Address-
Depression-Among-Pregnant-and-Postpartum-Women.pdf