Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a benefit that makes sure necessary health services are available for Medicaid-eligible children and adolescents under the age of 21, even if the service is not usually covered by NC Medicaid. Through EPSDT, Vaya will cover services, products, and procedures for Medicaid-eligible children and adolescents under age 21 if the service is medically necessary to correct a physical or mental illness, condition, or defect found through a screening examination.
Early and Periodic Screening
We know that the early years of a child’s life are an important time to support lifelong physical, social, and emotional well-being. Regular health check-ups and screenings are important for children under 21. These preventive services are free and include a full exam, shots, and vision and hearing tests. At these visits, the doctor checks your child’s growth, physical health, and emotional health. If there are any issues, the doctor can refer your child for needed treatments.
Diagnostic Services
If a screening finds something wrong, diagnostic services are available to figure out (diagnose) what the health issue is so it can be treated.
Treatment Services
If your child needs medical treatment, EPSDT makes sure Medicaid will cover the needed services, even if they aren’t part of the usual coverage. The treatment may need to be verified that it is medically necessary to help your child’s condition or overall health, this is called a prior approval. If the treatment is needed for your child’s health, Vaya won’t deny a service just because it’s not in our regular policy.
EPSDT Services Include:
- Comprehensive health screening services (well-child checks, developmental screenings, and immunizations)
- Health and developmental history
- Laboratory tests
- Health education
- Hearing services (including diagnosis and treatment for hearing defects, including hearing aids)
- Vision services (including eyeglasses)
- Dental services (dentist will bill directly to NC Medicaid)
- Inpatient and outpatient hospital services
- Mental health services
- Personal care services
- Physical and occupational therapy
- Prescription drugs
- Prosthetics
- Rehabilitative and therapy services for speech, hearing, and language disorders
- Transportation to and from medical appointments
EPSDT Services Include:
- No Copays: There are no copays for Medicaid-covered services for members under 21.
- Unlimited Services: There are no limits on how often a service can be given or how many services can be received in one day.
- Flexible Service Locations: Services can be provided in the best place for the child’s health, including schools or community settings.
More Resources
- Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children information on the NC Medicaid website.
- Wellness Visits, and Diagnostic and Treatment Services information on the NC Medicaid website.
- Paving the Road to Good Health: Strategies for Increasing Medicaid Adolescent Well-Care Visits – a CMS resource.
Need Help or Have Questions?
- If you have questions about EPSDT services, talk with your child’s primary care provider (PCP). You can also learn more about EPSDT on the NC Medicaid EPSDT webpage.