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
- Includes vision and hearing
Developmental/Social/Behavioral Mental Health Screenings
- Includes a general screening as part of the EPSDT screening component.
- Includes laboratory tests, lead, tuberculosis and certain congenital condition screenings.
- If at the time of screening, it is determined that immunization is needed and appropriate to provide, then immunization treatment must be provided at that time.
Oral Health and Oral Health Services
- EPSDT covers oral health services. Oral health services are defined as those services provided by a qualified healthcare practitioner who is neither a dentist nor supervised by one.
- Includes oral screening at each visit and when applicable, fluoride varnish and fluoride supplementation.
- Includes medically necessary orthodontic services.
Health Education and Anticipatory Guidance
- Includes age-appropriate health education (including anticipatory guidance) at each screening.
- EPSDT covers, at a minimum, diagnosis and treatment to improve vision, including eyeglasses.
- EPSDT covers, at a minimum, dental services for relief of pain and infections, restoration of teeth and maintenance of dental health, including examinations, cleanings and fluoride treatments. Dental services are defined as those diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of his profession.
- EPSDT covers, at a minimum, diagnosis and treatment to improve hearing, including hearing aids.
Other Necessary Health Care Services
- Additional health care services that are coverable under the federal Medicaid program and found to be medically necessary to treat, correct or ameliorate illnesses and conditions discovered regardless of whether the service is covered by Healthy Connections Medicaid. Medical necessity is determined by Healthy Connections Medicaid on a case-by-case basis (see medical necessity below for more information).
- EPSDT covers diagnostic services when a screening indicates the need for further evaluation.
- EPSDT covers necessary health care services for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.
- EPSDT covers lead screening.