Early and Periodic Screening Diagnosis and Treatment (EPSDT)
EPSDT Program (HealthWatch)
CareSource covers screening services through an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. This program covers medical and wellness exams, immunizations (shots), health education and laboratory tests for everyone eligible for Medicaid under the age of 21 years.
This includes all Healthy Indiana Plan (HIP) members and Hoosier Healthwise (HHW) members from birth through the month of their 21st birthday.
These exams are important to make sure that children are healthy and are developing physically and mentally. Mothers should have prenatal exams and children should have exams at the following ages:
- 3-5 days
- 1 month
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months
- 24 months
- 30 months
- At three years old, once a year, every year
Medically Necessary Follow-Up Care
Follow-up care includes physical, behavioral or other health problems or issues found during a screening. This could include, but is not limited to, services such as:
- Visits with a primary medical provider (PMP), specialist, dentist, hearing, vision, and other CareSource providers to diagnose and treat problems or issues
- Inpatient or outpatient hospital care
- Clinic visits
- Prescription drugs
- Laboratory tests, including lead screening
- Health education
Schedule an EPSDT Preventative Health Visit With Your Child’s PMP
It is very important to get preventive checkups and screenings so your providers can find any health problems early and treat them, or make a referral to a specialist for treatment, before the problem gets more serious. Some services may require a referral from your PMP or prior authorization by CareSource. Also, for some EPSDT items or services, your provider may request prior authorization for CareSource to cover things that have limits.As a part of EPSDT, care management services are available to all members who have special health care needs.
To schedule an EPSDT preventive health visit, call your PMP. Make sure to ask for an EPSDT preventive health visit when you call. CareSource asks that you schedule exams for all eligible family members regularly. You should have your child’s first exam within 90 days of becoming a member.
If you would like more information about the program, please contact our Member Services department at the number below. We can help you access care, find a provider, make an appointment, find out what services are covered and which ones may need prior authorization, or arrange transportation, if needed.
Member Services: 1-844-607-2829 (TTY: 1-800-743-3333), 8 a.m. to 8 p.m., Monday – Friday