Early and Periodic Screening Diagnosis and Treatment (EPSDT)
EPSDT is the key to making sure children, adolescents and older youth get the preventive health services and specialty services needed to stay healthy and get the right care.
EPSDT benefits are available at no cost to members.
Parenting can be busy and stressful. Make sure you keep your child’s health at the top of your list! Your child can get free EPSDT visits. EPSDT stands for:
E – Early, Take your child for health check-ups early and on a regular schedule so any health issues identified are treated quickly and your child stays healthy.
P – Periodic, Regular preventive (well care) visits recommended at certain ages from birth (infants) and continuing through the month that your child turns 21 years old.
S – Screening, Providing physical, mental, substance use, developmental, dental, hearing, vision, and other screening tests/services to identify potential problems.
D – Diagnosis, When your child goes to the doctor regularly, you and the doctor (provider) may see the need for more diagnostic tests or evaluation to follow-up when a health issue or risk is found or suspected.
T – Treatment, Your child’s doctor may provide treatment during a preventive visit or refer your child to a Specialty doctor for the right treatment to correct or reduce any health issues found.
EPSDT preventive exams and health screenings are important to make sure children are healthy, and stay healthy as they grow up. Pregnant women are recommended to have good prenatal care and check-ups after they have their child. Once their child is born, regular EPSDT preventive exams and health screenings are recommended at the following ages:
- 3-5 days
- 1 month
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months(1 year old)
- 15 months
- 18 months
- 24 months (2 years old)
- 30 months (2 ½ years old)
- 3+ years old *
* Beginning at three years of age, it is recommended your child get an EPSDT preventive visit once a year (more than once a year if there is a health reason).
Medicaid’s EPSDT Preventive Services:
Regular physical exams and health screening services for infants, children, adolescents, teens & older youth (birth to end of 21st birth month). Regular EPSDT visits find health issues early (including mental health, growth & developmental) so additional testing, evaluation or treatment can start right away. EPSDT preventive services are available at the recommended ages and at other times when needed.
EPSDT Preventive Visits Include:
- Comprehensive health and developmental history
- Comprehensive unclothed physical exam (Measurements, Sensory, Procedures)
- Laboratory tests (including lead toxicity screening)
- Screenings (Mental Health/Depression/Substance Use/Developmental/Dental/Hearing/Vision/Lead, other)
- Dental Screenings & Referrals to Dental Providers
- Health Education & Guidance (age appropriate development, healthy lifestyles, accident & disease prevention, at-risk and risk behaviors, safety)
- Referrals for further diagnosis and treatment
EPSDT Special Services Include:
Other health care, testing/diagnosis and treatment services that are medically necessary to correct or improve a physical, developmental or mental health condition of a child or youth. All EPSDT Special Services will need to be Medically Necessary, must have a prior authorization and be pre-approved; your child’s doctor can assist you with this.
EPSDT preventive exams and screenings are very important for children & youth and their parents, so your providers can find health problems early and treat them, or make referrals to a specialist for the right treatment, so a health issue is treated quickly.
Parents, their children and their providers (doctors, Nurses, etc.) are a TEAM and you work together to make certain your children get the right care, at the right time!
As a part of the EPSDT Program, care management services are available to all members from birth through the month they turn 21 years old who have special health care needs. If you would like more information on the EPSDT program, please call Member Services at 1-855-852-7005 (TTY: 1-800-648-6056 or 711).
Member Services: 1-855-852-7005 (TTY: 1-800-648-6056 or 711), 7 a.m. – 7 p.m., Monday – Friday