What is EPSDT?
Early Periodic Screening, Diagnostic and Treatment, or EPSDT, is the Medicaid program's benefit that covers checkups and health care services for children from birth until age 21 to detect and treat health problems. EPSDT checkups are free for all children and youth who have Healthy Connections Medicaid.
Often referred to as well-child visits, EPSDT finds children with actual or potential health problems and screens, diagnoses and treats the problems before they become permanent, lifelong disabilities. EPSDT also offers preventive health services to Healthy Connections Medicaid beneficiaries under 21 years old. It includes the regular health checkup, the EPSDT screenings as part of a well-child visit and EPSDT special services should a referral to a specialist be needed.
EPSDT is key to ensuring that children and youth receive appropriate dental, mental health, developmental and specialty services as soon as possible.
Early: Checking and identifying problems early.
Periodic: Examining children's health at regular or periodic age-appropriate intervals.
Screening: Providing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems.
Diagnostic: Performing special or specific tests to follow up when a risk is identified.
Treatment: Controlling, correcting or reducing health problems found.
Coverage and Requirements
Services must be ordered by the child's physician or another licensed clinician. Prior approval from SCDHHS may be required to verify medical necessity for some services. Covered services:
- Must be medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that is identified through a screening examination.
- Must be listed in section 1905(a) of the Social Security Act.
- Must not be experimental/investigational, unsafe or considered ineffective.