Determinations may be appealed in writing stating what and why you are appealing (why you think the decision made or action taken is wrong). Please include a copy of the notice or denial you received with your letter and be sure to include complete contact information for you and your representative (if you have one). Please submit your appeal online.

All EPSDT requirements must be adhered to for individuals who receive services under managed care arrangements. SCDHHS is responsible for medical necessary services not included in the Managed Care Organization (MCO) contract.

All coverable, medically necessary, services must be provided even if the service is not available under Healthy Connections Medicaid to beneficiaries through the month of their 21st birthday. Additional health care services are available under the federal Medicaid program if they are medically necessary to treat, correct or ameliorate illnesses and conditions discovered regardless of whether the service is covered by the State Plan.

Immunizations are a required component of EPSDT screening services. An assessment of the child’s immunization status should be made at each screening and immunizations should be administered as appropriate. If a child is unable to be immunized due to illness, the reason for delay should be documented in the child’s record. If your practice does not routinely administer immunizations, then the child should be referred to the county health department for that service. The provider should still maintain a record of the child’s immunization status.  

A periodicity schedule describes the set of screenings, procedures and services applicable at each stage of a beneficiary’s development, from birth through the last day of the month of their 21st birthday, that are based on recognized standards of medical and dental practice. 

South Carolina Healthy Connections Medicaid has established the following schedules for preventive pediatric health care:

Periodicity Schedules

Medical Periodicity Schedule

Screening Services

EPSDT covers regular screening services (check-ups) for infants, children and adolescents. These screenings are designed to identify health and developmental issues as early as possible. Covered screening services are medical, mental health, vision, hearing and dental.

Covered Screening Services

Comprehensive Health and Physical Examination

• Includes history, measurements, unclothed age-appropriate physical examination

Sensory Screening

EARLY: Assessing and identifying problems early 

Children covered by Medicaid are more likely to be born with low birth weights, have poor health, have developmental delays or learning disorders, or have medical conditions (e.g., asthma) requiring ongoing use of prescription drugs. Medicaid helps these children and adolescents receive quality health care.

States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines.

This website provides useful information and tools to put into practice the array of preventative services available through the EPSDT benefit of the South Carolina Healthy Connections Medicaid program for children birth to age 21.

Often referred to as a well-child visit, EPSDT is a child health benefit in the Healthy Connections Medicaid program. EPSDT is a program of checkups and health care services for children from birth until age 21 to detect and treat health problems.

During a scheduled checkup, your healthcare provider may ask for or provide: