EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is a benefit covering all children under 21 years of age that are enrolled in Medicaid. Under the program, the children enrolled through the “categorically needy” category are liable to receive early and periodic screening, diagnostic, and treatment benefits. The States are bound to offer access to services that are covered by Medicaid, irrespective of whether or not the state covers that particular service in its Medicaid program. For instance, even if the best Medicaid plans in NY do not cover orthodontic treatment for adults, it is provided for children below 21 years of age.
The plan mandates it for the states to inform the families enrolled in Medicaid about this plan and the benefits they can garner from it. The States are also responsible for screening the children at regular intervals, diagnosing health issues, and providing apt treatment before the health condition becomes serious. They should collect relevant data regarding EPSDT implementation and forward it to the Centers for Medicare and Medicaid Services.
The motive of EPSDT
The motive of this Medicaid plan is to diagnose childhood health conditions in their early stages to prevent serious consequences. EPSDT ensures that every eligible child and adolescent gets preventive, mental health, developmental, and dental services along with specialty services if needed.
Here is the breakdown of what’s covered under this plan:
Early: It denotes early assessment and identification of minor and major health problems.
Periodic: It denotes periodic check-ups at regular or age-appropriate intervals.
Screening: It denotes important screenings, i.e. physical, mental, dental, vision, hearing, developmental, and other important screenings to find out potential health issues.
Diagnostic: It denotes diagnostic tests for follow up after a risk is identified.
Treatment: It denotes offering apt treatment to deal with the diagnosed health condition.
Services covered under EPSDT
As already mentioned, under EPSDT, the states are bound to offer comprehensive services and services covered under Medicaid for treatment of health conditions in children below 21 years of age.
Listed below are the screening, diagnostic, as well as treatment services that are covered under this special program:
- Screening services
Screening services include-
- Unclothed physical examination
- Laboratory tests
- Immunization
- Health and developmental history
- Providing health education (child development, accident and disease prevention, and a healthy lifestyle)
- Dental services
Dental services include:
- Restoration of teeth
- Treatment for pain, as well as infection
- Dental health maintenance
In collaboration with a reputed dental organization, the states must inculcate a periodicity schedule for the diagnosis and treatment of dental diseases.
- Vision Services
Vision services include diagnosis and treatment of vision defects, including eyeglasses.
- Hearing Services
Hearing services include diagnosis and treatment of hearing defects, including hearing aids.
- Other healthcare services
States must offer additional healthcare services covered under the Federal Medicaid program and which are important for the treatment of a medical condition irrespective of whether it is covered under the particular state’s Medicaid plan or not.
- Diagnostic services
If the screening necessitates further evaluation or assessment of the child’s health, diagnostic services must be extended by the states, along with follow-ups and referrals.
- Treatment
States must provide for the treatment of all the physical as well as mental conditions diagnosed via screening and diagnostic procedures.
The bottom line
By offering comprehensive health care services to the eligible candidates, Medicaid supports hundreds and thousands of Americans who can’t afford premium medical services. This serves as a backbone to the economic class that falls in the strata of low income in the country as well as the population that falls in the underprivileged sections of society.
Moreover, with EPSDT, the federal government ensures to cover the children in its protective umbrella. EPSDT is indeed a laudable organ of the entire Medicaid program.
