What is EPSDT?
EPSDT is a Medicaid and Dr. Dynasaur for children and youth under age 21. It tries to keep children as healthy as possible. EPSDT stands for Early Periodic Screening Diagnostic Treatment. It should:
- Find problems early, starting at birth
- Check children's health at regular set times
- Use check-up tests to find any problems
- Do follow-up tests if problems are found and
- Treat any health problems found
How EPSDT Works
EPSDT is a federal law. It says the state must pay for any medically needed health care service. Medically needed means it is for that health problem. AND that this is what most doctors would do to treat the problem. It pays for some services that it won’t cover for adults. Some services need to be OK’d first.
EPSDT Covers
- Regular check-ups
- Tests on how the child is growing and learning
- Shots
- Eye tests
- Hearing tests
- Checks for lead poison
- Dental visits
- Counseling
How often does a child get check-ups?
There is a list of the health check-ups children and youth should get every year. Click here to see the list: Recommendations for Preventative Pediatric Health Care. To see the dental check-up list, click here: Vermont Preventive Pediatric Oral Health Care.
EPSDT does not pay for:
- Services or items that are not in federal Medicaid laws (Section 1905(a) of the Social Security Act).
- Experimental care that is not safe or does not work.
- High-cost services or items if a cheaper one will work just as well.
- Services that are not medical.