HealthCheck Training: Overview
The EPSDT Benefit: Requirements
Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit focuses on eligible low-income children and teens ages birth to 21. EPSDT emphasizes preventive care, especially screening services, to promote good health and identify and treat problems early and effectively.
EPSDT is a joint federal-state partnership benefit administered by the Centers for Medicare & Medicaid Services (CMS). The benefit has two operational components:
- Assuring the availability and accessibility of required health care resources.
- Helping Medicaid beneficiaries and their parents or guardians effectively use these resources.
CMS, state Medicaid agencies, and EPSDT providers have a shared obligation to ensure comprehensive pediatric preventive care for eligible children and teens, and to support their families in accessing the health services available through EPSDT .
The Centers for Medicare & Medicaid Services (CMS) requires states to ensure that all Medicaid-eligible children and youth receive comprehensive health services, especially early and periodic screening, diagnostic, and treatment (EPSDT) services. In DC, EPSDT services are called HealthCheck.
In general, EPSDT services include:
- Early and comprehensive health care to assess a child's health status, identify risks or concerns, and intervene promptly.
- Periodic well-child visits at recommended age-appropriate intervals (periodicity).
- Screening services including health history, physical exam, tests and assessments, immunizations, and health guidance.
- Diagnostic services to determine the nature and cause of identified health problems and evaluate treatment options.
- Treatment services, including early intervention, to correct or improve physical, developmental, and mental health conditions.
For a detailed description of requirements, coordination, and administration see the EPSDT Manual developed by the Centers for Medicare and Medicaid Services (See Chapter 5 of the State Medicaid Manual)
For more information on EPSDT services, see the HealthCheck Resources page.
Required EPSDT Health Services
The EPSDT benefit mandates the following preventive health services:
- Comprehensive health and developmental history (physical, mental, and developmental)
- Comprehensive unclothed physical exam
- Appropriate immunizations
- Laboratory tests, including mandatory lead screening
- Health education and anticipatory guidance
- Vision screening
- Hearing screening
- Dental screening
- Other necessary health care
- Diagnostic services, if needed for further evaluation
- Treatment (or referrals) to correct or improve health conditions
The EPSDT benefit requires each state to develop an approved schedule of preventive health visits at regular intervals that meet reasonable standards of medical practice. Vision, hearing, and dental screening services must also be provided at intervals specified by the state.
The following pages provide a general overview of HealthCheck, the District of Columbia's EPSDT benefit.