The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services. Each of the descriptive terms in the EPSDT benefit are defined below.
Early: Assessing and identifying problems early
Children covered by Medicaid are more likely to be born with low birth weights, have poor health, have developmental delays or learning disorders, or have medical conditions (e.g., asthma) requiring ongoing use of prescription drugs. Medicaid helps these children and adolescents receive quality health care.
EPSDT is a key part of Medicaid for children and adolescents. EPSDT emphasizes preventive and comprehensive care. Prevention can help ensure the early identification, diagnosis, and treatment of conditions before they become more complex and costly to treat. It is important that children and adolescents enrolled in Medicaid receive all recommended preventive services and any medical treatment needed to promote healthy growth and development.
Periodic: Checking children’s health at age-appropriate intervals
As they grow, infants, children, and adolescents should see their health care providers regularly. Each state develops its own “periodicity schedule” showing the check-ups recommended at each age. These are often based on the American Academy of Pediatrics’ Bright Futures guidelines: Recommendations for Preventive Pediatric Health Care. Bright Futures helps doctors and families understand the types of care that infants, children, and adolescents should get and when they should get it. The goal of Bright Futures is to help health care providers offer prevention-based, family focused, and developmentally-oriented care for all children and adolescents. Children and adolescents are also entitled to receive additional check-ups when a condition or problem is suspected.
Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
All infants, children, and adolescents should receive regular well-child check-ups of their physical and mental health, growth, development, and nutritional status. A well-child check-up includes:
- A comprehensive health and developmental history, including both physical and mental health development assessments
- Physical exam
- Age-appropriate immunizations
- Vision and hearing tests
- Dental exam
- Laboratory tests, including blood lead level assessments at certain ages
- Health education, including anticipatory guidance
Diagnostic: Performing diagnostic tests to follow up when a health risk is identified
When a well-child check-up or other visit to a health care professional shows that a child or adolescent might have a health problem, follow-up diagnostic testing and evaluations must be provided under EPSDT. Diagnosis of mental health, substance use, vision, hearing, and dental problems is included. Also included are any necessary referrals so that the child or adolescent receives all needed treatment.
Treatment: Correct, reduce, or control health problems found
EPSDT covers health care, treatment, and other measures necessary to correct or ameliorate the child or adolescent’s physical or mental conditions found by a screening or a diagnostic procedure. In general, states must ensure the provision of, and pay for, any treatment that is considered “medically necessary” for the child or adolescent. This includes treatment for any vision and hearing problems, including eyeglasses and hearing aids. For children’s oral health, coverage includes regular preventive dental care and treatment to relieve pain and infections, restore teeth, and maintain dental health. Some orthodontia is also covered.
Last Updated: August 29, 2023