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For Members and Families

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:

  • Health history
  • Complete physical exam
  • Lab tests (as needed)
  • Immunizations
  • Vision and hearing screening
  • Development/social/behavioral screening (as needed)
  • Advice on how to keep your child healthy

Checkups are needed on a regular basis to monitor growth and development. Learn how often children should receive checkups by reading the Well-Child Visit Schedule below.

Take your child to your healthcare provider any time your child is sick. If you or someone who works with your child suspects a physical, mental or development problem, take your child to the doctor even if it is not time for a checkup.

Covered Benefits and Services

EPSDT Screening

Through the EPSDT benefit children can get free checkups early on and access to mandatory periodic examinations and evaluations, which are helpful to assess, diagnose and treat your child’s health needs. Contact your doctor that accepts Healthy Connections Medicaid to schedule these appointments.

The EPSDT screening includes:

  • Checking a child’s growth and size.
  • Checking a child’s ears and eyes.
  • Reviewing vaccine records and getting needed shots.
  • Evaluating health and developmental/social/behavioral mental health and skills.
  • Providing health education and anticapatory guidance.
  • Reviewing diet and nutrition.
  • Performing a developmental review assessment.
  • Providing a TB risk review and skin test.
  • Evaluating lead risk assessment.
  • Cervical Dysplasia screening as recommended by your doctor.
  • Evaluating mouth, teeth and fluoride varnish.
  • Collecting blood and reviewing blood test records.

Covered Dental Services

EPSDT dental services are defined as the diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of his/her profession.

EPSDT covers the following dental services:

  • Relief of pain and infection.
  • Restoration of teeth.
  • Maintenance of dental health, including examinations, cleanings and flouride treatments.
Well-Child Visit Schedule

Well-child visits are needed on a regular basis to monitor growth and development.

American Academy of Pediatrics (AAP) Periodicity Schedule for Children and Youth

Infancy 

  • Newborn, within one week
  • 1 Month
  • 2 Months
  • 4 Months
  • 6 Months
  • 9 Months

Early Childhood

  • 12 Months/1 Year
  • 15 Months
  • 18 Months
  • 24 Months/2 Years
  • 30 Months
  • 3 Years
  • 4 Years

Middle Childhood

  • 5 Years
  • 6 Years
  • 7 Years
  • 8 Years
  • 9 Years
  • 10 Years

Adolescence

  • 11 Years
  • 12 Years
  • 13 Years
  • 14 Years
  • 15 Years
  • 16 Years
  • 17 Years
  • 18 Years
  • 19 Years
  • 20 Years
  • 21 Years
Immunizations

 As a parent, you want to give your child a healthy start in life. Immunizations, generally given as shots, are the best way parents can protect their children from serious diseases.

Immunizations are a required part of EPSDT screening services. If your child is due for an immunization, it should be given at the time of the screening. However, if the child is ill and cannot get an immunization at the time of the screening then an appointment should be given to return for the immunization at a later date. If your provider does not administer immunizations then you should be referred to the county health department for that service.

Immunization Resources:

Health Plans

Members in the South Carolina Healthy Connections program can choose a health plan and doctor for each eligible member in your family.

If you have not selected a health plan, read the How to Choose Your Health Plan and Doctor guide.

If you are a member in a managed care health plan and have questions about your EPSDT benefit, please contact your health plan directly:

FAQs

Who qualifies for EPSDT?  

Children and youth under age 21 who are enrolled in Healthy Connections Medicaid.

Are children in foster care eligible for EPSDT?  

Yes, children in foster care can receive prevention, screening, and treatment services until they turn  21 years old.

What happens when my child turns 21 years old?  

Individuals who turn 21 are no longer eligible for the EPSDT benefit but may still be eligible for coverage under Medicaid.  Visit scdhhs.gov for more information about Healthy Connections Medicaid eligibility.

How often should I take my child to the doctor for a well-child visit?  

View the Well-Child Visit Schedule section above to learn when you should take your child for a regulat well-child visit.

Is there a copay for EPSDT/well-child doctor visits?  

There are no co-payments for well-child visits from birth through the month of the child's 21st birthday.

Is lead exposure screening required?  

Lead exposure screening is a requirement for all Medicaid-enrolled children at 12 and 24 months or between the ages of 36 and 72 months if not previously tested. 

What does medically necessary mean?   

Medically necessary services are health care services or supplies needed to identify or treat an illness, injury, condition, disease, or its symptoms. The services or supplies must meet acceptable standards of medicine. 

Is transportation and mileage reimbursement available to access the EPSDT benefit?  

SCDHHS offers non-emergency transportation assistance and mileage reimbursement for most covered Medicaid services.  For more information visit the transportation provider’s website .

How does my child qualify for non-income based health care through the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)? 

Healthy Connections provides benefits to certain children with disabilities who would not ordinarily be eligible because their parents’ income and/or resources exceed the limit. Please visit scdhhs.gov for eligibility requirements. If you would like more information on TEFRA or need help completing the TEFRA application you can contact Family Connection of SC at (800) 578-8750.

How can I apply for Autism Spectrum Disorder (ASD) services for my child?

In order to apply for Healthy Connections Medicaid ASD treatment services, the following information is required:

  • Healthy Connections Medicaid member identification (ID) number 
  • Beneficiary age between 0-21 
  • Comprehensive assessment report with established diagnosis of ASD. Please contact an ASD provider directly to assist in requesting an authorization for ASD program services. 

How do I apply for South Carolina Healthy Connections Medicaid?  

To apply for Healthy Connections, you will need to complete and submit an application.  You may apply online at apply.scdhhs.gov. SC Thrive is available to assist you with the online Healthy Connections application and can provide an assessment of your household's most likely health coverage options. Please contact their helpline at (800) 726-8774 or visit them online at scthrive.org if you have questions or need assistance.  

You may also apply in person at your local county office or contact our main customer service line at (888) 549-0820. In addition, you may apply in person at federally qualified rural health centers and at some hospitals.  For more information, including what you need to complete an application, please visit scdhhs.gov.