The early and periodic screening, diagnosis, and treatment (EPSDT) benefit provides comprehensive and preventative health care services for children under the age of 21 who are enrolled in Medicaid. EPSDT ensures that children and adolescents receive appropriate preventative, developmental, dental, mental health, and specialty services. EPSDT's rules support the health needs of low-income children and those with special health needs who meet the criteria for assistance. Although states may decide whether they want to cover services for adults, medically necessary services for children must be covered under the federal EPSDT mandate. States are able to set medical necessity and other criteria that may affect coverage and reimbursement restrictions.
The following information from Medicaid.gov provides an overview of services covered under EPSDT.
|Early||Assessing and identifying problems early|
|Periodic||Checking children's health at periodic, age-appropriate intervals|
|Screening||Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems|
|Diagnosis||Performing diagnostic tests to follow up when a risk is identified|
|Treatment||Controlling, correcting, or reducing health problems found|
The service delivery setting will affect implementation of the EPSDT benefit. For example, audiologists and speech-language pathologists may provide diagnostic and treatment services in the medical home service delivery model. Alternatively, many EPSDT services are provided within the school setting.
Professionals and state associations can advocate to ensure EPSDT coverage in state plans, including services of audiologists and speech-language pathologists for both evaluation and treatment under EPSDT coverage.