EPSDT

What is EPSDT?

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program is a child health initiative for Medical Assistance members.

Think of it like this:

• Early: Assessing and identifying problems early
• Periodic: Checking children's health at periodic, age-appropriate intervals
• Screening: Providing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems
• Diagnostic: Performing diagnostic tests to follow up when a risk is identified
• Treatment: Control, correct or reduce health problems found.

Your child’s good health starts with having regular checkups with their doctor. Your child's doctor will complete a yearly physical exam to make sure they are growing well. During this yearly visit they will also conduct do some preventive tests based on your child’s situation. These screenings ensure they do not have any health problems. Learn more about the program and when certain screenings should be done in our program brochure.

Growing up with Highmark Wholecare brochure
Growing up with Highmark Wholecare brochure (Spanish)

Services

Vision Services

Vision care that finds and treats defects in your child’s vision is covered. This includes eyeglasses. Eye doctor visits must follow a specific schedule developed by the state. Other services may happen as needed. For details, visit the Medicaid EPSDT vision and hearing page

Dental Services

Dental services that maintain dental health are included in this program. Relieving pain and treating infections is also part of the EPSDT program. If your child’s teeth need to be restored, that is also something that could be covered. Routine care must follow a specific schedule developed by the state. Dental care may not be limited to emergency services.

Hearing Services

Hearing services that uncover and treat hearing issues are covered. Hearing tests must follow the schedule developed by the state. This allows hearing loss to be found as early as possible. For more information visit the Medicaid EPSDT vision and hearing page

Diagnostic Services

When an exam shows that something needs further tests, diagnostic services are covered. Referrals that are necessary for these tests should be made quickly. To make sure members get a complete evaluation there should be follow-up. Each state should create procedures to ensure all the care that is needed is provided. 

Treatment

Once an illness or condition is discovered, all the necessary health care to treat the problem should be given.

Other Necessary Health Care Services

Each state provides any health care services needed to treat or correct an illness the federal Medicaid program covers. This includes services that the state program would not usually cover. The state decides what is necessary in each case.