EPSDT

EPSDT

Special Health Matters

2290 E. 4500 S. #170, Salt Lake City, UT 84117-4428

Phone: 801.272.1051 Fax: 801.272.8907

Toll Free: 800.468.1160 Español: 801.272.1067

What is EPSDT?

Medicaid’s child health component, known as the Early and Periodic Screening, Diagnosis, and

Treatment (EPSDT) program, has been shaped to fit the standards of pediatric care and

to meet the special physical, emotional, and developmental needs of low-income children.

Federal law – including statutes, regulations, and guidelines – requires that Medicaid cover a very

comprehensive set of benefits and services for children, different from adult benefits. Since one in

three U.S. children under age six is eligible for Medicaid, EPSDT offers a very important way to

ensure that young children receive appropriate health, mental health, and developmental

services.

sEarly---Identifying problems early, starting at birth

s Periodic---Checking children's health at periodic, age-appropriate intervals

sScreening---Doing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems

sDiagnosis---Performing diagnostic tests to follow up when a risk is identified

sTreatment---Treating the problems found.

What are the EPSDT requirements?

EPSDT is a mandatory set of services and benefits for all individuals under age 21 who are

enrolled in Medicaid. Think of it as the child health coverage package of Medicaid.

Screening services "to detect physical and mental conditions must be covered at established,

periodic intervals (periodic screens) and whenever a problem is suspected (inter-periodic

screens). Screening includes a comprehensive health and developmental history, an unclothed physical

exam, appropriate immunizations, laboratory tests, and health education.

In addition, dental, vision, and hearing services are required, including appropriate screening,

diagnostic, and treatment. The treatment component of EPSDT is broadly defined. Federal law

states that treatment must include any "necessary health care, diagnostic services, treatment,

and other measures" that fall within the federal definition of medical assistance (as described in

Section 1905(a) of the Social Security Act that are needed to "correct or ameliorate defects and

physical and mental illnesses and conditions discovered by the screening services."

medical assistance must be covered, regardless of whether or not such services are otherwise

covered under the state Medicaid plan for adults ages 21 and older.

Resources

The selected titles and links below will guide you to some key resources and references.

http://www.gwumc.edu/sphhs/healthpolicy/chsrp/newsps/

http://www.gwumc.edu/sphhs/healthpolicy/chsrp/downloads/mil_prep042605.pdf