The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit under section 1905(a) of the Social Security Act applies to all Medicaid enrolled children and youth under 21 years old. The goal of EPSDT is to ensure that individual children and youth get the health care they need when they need it. 

What is EPSDT? 

  • EPSDT stands for the Early and Periodic Screening, Diagnostic, and Treatment.
  • It is a benefit that provides health care services for children under 21 years old who are enrolled in Medicaid. It makes sure that children and youth get the services they need, as soon as they need them.
  • EPSDT means:
    • Early: Catching problems or health risks early.
    • Periodic: Regular check-ups.
    • Screening: Providing physical, mental, developmental, dental, hearing, vision and other screening tests.
    • Diagnostic: Tests to follow up when a risk is found.
    • Treatment: Control, correct or reduce health problems found. 

Things you should know about the EPSDT benefit: 

  • EPSDT covers treatments children and youth need to correct or improve birth defects, physical health and behavioral conditions.
  • The benefit is greater than the benefit for adults, emphasizing early care to prevent or treat health issues.
  • Quick identification of problems can help avoid increased disabilities. It can also help make sure children and youth achieve their future life goals.
  • Treatment decisions are based on individual needs. 

How to access EPSDT: 

  • Speak with your child's treatment team to get them EPSDT services. 

Your rights: 

  • You have the right to appeal if medical services are denied or not acted upon.
  • You can also file a grievance with your managed care organization, if needed.