EPSDT stands for Early and Periodic Screening, Diagnosis and Treatment. It is a service which is available to every Medicaid-eligible child under age 21. It has two parts: screening (or well-child check-ups) and treatment.

Under EPSDT, the state must provide or arrange for four separate periodic screens: medical, vision, hearing and dental.

Medical screens must include the following:

• a comprehensive health and developmental history, including assessment of physical and mental health and development
• a comprehensive unclothed exam
• appropriate immunizations according to age and health history
• laboratory tests, including blood lead level assessments appropriate for age and risk factors
• health education, including anticipatory guidance.

Vision and hearing screens must be age appropriate and sufficient to diagnose defects. Dental screen must be performed by a dentist or by dental paraprofessionals under the direct supervision of a dentist.

Even children who seem well should have EPSDT check-ups. At a minimum, a check-up must be done at:

• under 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 2 years
• 3 years
• 4-5 years
• 6-8 years
• 9-12 years
• 13-16 years
• 17-20 years

EPSDT covers medically necessary diagnostic and treatment services to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services. If they are "medically necessary," covered services can include:

• case management
• home health care
• personal care
• nursing services
• lab, x-ray, medications
• transportation
• rehabilitation
• durable medical equipment
• hearing aids, eyeglasses
• relief of pain and infections, restoration of teeth, and maintenance of dental health (medically necessary orthodontic care)
• any other type of remedial care recognized under state law, furnished by licensed practitioners within the scope of their practice

For more information about what services are available under the EPSDT program, where the services are available and how to obtain them, or for assistance with scheduling and transportation, call your HMO or primary care provider, or you may call 800/522-0310.

last modified: January 1999