Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Benefit
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EPSDT is pediatric preventive care for Indiana children and young adults. EPSDT stands for Early and Periodic Screening, Diagnosis, and Treatment. The program is designed to improve the overall health of Medicaid eligible children by ensuring that they get the medical screening and testing they need to help prevent and/or find out about childhood diseases and illnesses early.
Who Qualifies?All Medicaid enrolled individuals from birth to twenty-one (21) years of age may participate in the EPSDT program.
Early and Periodic ScreeningTo keep your children healthy, regular EPSDT screenings should be scheduled with your child's regular doctor (Primary Care Physician or PCP). It is recommended that visits be scheduled at the following intervals:
Your child's doctor will typically provide the following services during an EPSDT visit:
What to Expect During an EPSDT Visit:Your child’s regular doctor will use these visits to make sure that your child is healthy and developing well. Your child will get a physical exam along with hearing, vision, or other screening tests. Your doctor may ask questions such as:
An EPDST visit is also a great time to have school, sports, or camp physicals completed. Diagnosis and TreatmentEPSDT checkups may help your child’s doctor find and treat health conditions before they become more serious. The physician will perform diagnostic tests to follow up when a risk is identified. If a test result detects a problem, your child’s Medicaid coverage must pay for medically necessary treatment services. Your child’s regular doctor may provide treatment or refer your child to a specialist for follow-up care. If a treatment maintains a child’s current condition or makes it easier for a child to live with that condition, in general, it must be covered by EPSDT. Treating the problems found without delay/early intervention can improve outcomes.
What if Treatment is Denied?Treatment under EPSDT must be medically necessary, a Medicaid-covered service, and provided by an approved provider. If your child has a service denied, you will receive written notification of denial, along with instructions for appeal.
Where to Learn MoreTo learn more about EPSDT, including how to schedule these visits for your child and transportation to get there, contact the Health Plan your child is enrolled with: https://www.in.gov/medicaid/members/135.htm
General information can be found at: https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html or by calling the Moms Helpline: 1-844-624-6667 |
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Programs and systems change often. It is important to ensure that you are using the most current information. Please check https://www.inf2f.org/fact-sheets.html for the most recent edition.
This fact sheet was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $96,750 with 89% percent financed with nongovernmental sources. The contents are those of INF2F and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
This fact sheet was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $96,750 with 89% percent financed with nongovernmental sources. The contents are those of INF2F and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
