EPSDT Services in Medicaid
Professional Resource Guide
This professional resource guide points to resources about providing and strengthening Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services in Medicaid. It includes tools for state Medicaid programs, health care practices, training, and finding data and statistics, journal articles, reports, and other materials.
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Resources for Professionals
1. Overview ▼ Show
- The EPSDT benefit provides comprehensive and preventive health care services
for children under age 21 who
are enrolled in Medicaid. States are given
some flexibility in determining the periodicity or timing of the health visits
and screenings, but the content of services is mandated by federal law to include
- Comprehensive health and developmental history, including
a developmental assessment of physical and mental health
- Comprehensive physical examination
- Immunizations, based on the current approved Advisory Committee
on Immunization Practices schedule
- Laboratory tests, including lead toxicity screening
- Vision, hearing, and dental services and other necessary health care
- Health education (anticipatory guidance including child development, healthy lifestyles, and injury and disease prevention)
- Diagnosis and treatment
- Comprehensive health and developmental history, including a developmental assessment of physical and mental health
- EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents (Centers for Medicare and Medicaid Services). This guide outlines: EPSDT’s screening requirements, including when interperiodic screening should be provided; Scope of services covered under EPSDT; EPSDT’s requirements governing dental, vision, and hearing services; Permissible limitations on service coverage under EPSDT; States’ responsibilities to assure access to EPSDT services and providers; Assistance to states as they work with managed care plans to provide the best child health benefit possible; and Notice and appeal procedures required when services are denied, reduced or terminated.
- EPSDT is Essential (National Health Law Program). This issue brief describes screenings delivered through ESPDT, how services are covered, how EPSDT differs from private insurance, how it integrates with the Children's Health Insurance Program (CHIP), and how to disseminate information on EPSDT services to children and families.
2. EPSDT Policy ▼ Show
- Catalyst Center: Medicaid and Children with Special Health Care Needs. Fact sheets, infographic, tutorial, webinars, and other resources for policymakers, program administrators, and health professionals about the role that Medicaid and the EPSDT benefit play in supporting the health and well-being of children with special health care needs and their families.
- Center for Children and Families (CCF): Medicaid. Analyses of policy developments and implementation efforts related to Medicaid on topics that include delivery system reform; eligibility and coverage; facts and statistics; financing; legislation, regulation, and guidance; program design; and waivers.
- Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB): EPSDT. Information about EPSDT and about opportunities for collaboration between Title V and Medicaid to improve EPSDT services. Presents strategies for improving EPSDT administration and performance. Resources address systems of care issues, family supports, data monitoring, and evolving EPSDT policy.
- Medicaid.gov: Early and Periodic Screening, Diagnostic and Treatment. Information about services covered, state program guidelines, periodicity schedules, and data. Includes a set of strategy guides to support states and their partners as they implement the EPSDT benefit. Oral health, adolescent well care visits, mental health and substance use, and lead screening are some of the topics addressed. More broadly, Medicaid.gov presents information about Medicaid, the Children's Health Insurance Program (CHIP), and the Patient Protection and Affordable Care Act (ACA), including federal policy guidance and state-specific program information and data. Topics include benefits, cost sharing, delivery systems, eligibility, financing and reimbursement, managed care, outreach and enrollment, and quality of care.
- National Academy for State Health Policy (NASHP): EPSDT Resources to Improve Medicaid for Children and Adolescents. Information about strategies states use to ensure children and adolescents enrolled in Medicaid receive EPSDT services. Topics include medical necessity, initiatives to improve access, reporting and data collection, behavioral health, support to providers and families, care coordination, and oral health.
- National Health Law Program (NHeLP): Early and Periodic Screening, Diagnostic and Treatment. This search of their website provides resources about EPSDT that include fact sheets, issue briefs, case dockets, legal transmittals, and other resources. NHeLP litigates to ensure that eligible children receive the benefits to which they are legally entitled, provides technical assistance to state and local advocates working to implement EPSDT, and analyzes policies affecting children's health.
- Johnson K. EPSDT Overview. Presented at the ABCD Screening Academy, 07/10/2007.
3. Tools for Providing EPSDT Services ▼ Show
- AAP State EPSDT Profiles. Provide insight and detailed information about each Medicaid program’s EPSDT benefit and how it aligns with the Bright Futures 4th Edition and the AAP/Bright Futures Periodicity Schedule of preventive visits and screenings. The profiles also provide information on your state’s definition of medical necessity for EPSDT, promising practices related preventive care, as well as how the state performs on its selected Child Core Set measures.
- AAP’s Using Your State EPSDT Profile guidance to help brainstorm ways the EPSDT profiles can be useful in identifying and addressing state-specific issues.
- Bright Futures. Guidelines and tools for preventive health supervision and health screening for infants, children, and adolescents which can be used as a framework to improve EPSDT services. Includes health visit forms; developmental, behavioral, and psychosocial screening and assessment forms; an oral health risk assessment tool; and practice guides.
for Disease Control and Prevention (CDC). Resources relevant
to the provision of EPSDT services include
Developmental Monitoring and Screening. Information about developmental screening and why it's important. Includes monitoring and screening recommendations for health professionals and suggestions for integrating screening services into primary care.
Growth Charts. Tools and background information for plotting the growth of infants, children, and adolescents from birth through age 20. Also links to interactive training modules for health professionals using the pediatric growth charts in clinical and public health settings. The growth charts are available in English, Spanish, and French.
Hearing Loss in Children. Information about hearing screening, diagnosis, treatment, and intervention. Includes recommendations and guidelines for newborn hearing programs and audiologic screening for infants and children.
Immunization Schedules. Schedules and tracking tools for health professionals and families. Schedules are available in English and Spanish and in various formats.
Lead. Information about childhood lead exposure and prevention. Includes guidelines for screening and case management.
Newborn Screening. Program information, tools, and recommendations for health and lab professionals and families about newborn screening for certain genetic, endocrine, and metabolic disorders and hearing loss prior to discharge from a hospital or birthing center.
- Early Childhood Learning and Knowledge Center (ECLKC): Health. Information and tools about health and development, program planning, working with families, and staff support related to the provision of EPSDT services in the Head Start community. Head Start is a national program that serves the development needs of infants and children from birth through age 5 and their families with low incomes through the provision of education, health, nutrition, social, and other services. Includes an online directory of Head Start programs and links to state EPSDT periodicity schedules and other resources.
- National Center for Children's Vision and Eye Health. Education, training, and health promotion materials about children’s vision screening for pediatric primary care health professionals. Includes contact information for vision care financial assistance and information about school requirements for children's vision in each state.
- National Center for Hearing Assessment and Management (NCHAM). Resources for health professionals, policymakers, and program administrators about the implementation and improvement of Early Hearing Detection and Intervention (EHDI) systems for infants and children covered by EPSDT services in Medicaid and by other health insurance programs. Includes information about EHDI program components, training tools, state EHDI profiles and contacts, and federal and state EHDI legislation.
- National Maternal and Child Oral Health Resource Center (OHRC). Bibliography of materials about EPSDT oral health services, including a collection of reports about children’s utilization of these services in several states. OHRC also presents guidelines, schedules, health-education materials, and other resources for strengthening the oral health component of EPSDT services.
- U.S. Preventive Services Task Force: Child and Adolescent
Recommendations. Recommendations for preventive measures
in primary care, including screening, counseling, immunizations,
and preventive medications for cancer; cardiovascular disorders;
development and behavior; infectious diseases; injury prevention;
mental health conditions and substance abuse; metabolic, nutritional,
and endocrine conditions; musculoskeletal disorders; perinatal care;
and vision and hearing disorders.
4. Training ▼ Show
Futures at Georgetown University. Web-based curricula, training
tools, and other resources for health professionals and families for
a practical developmental approach to
providing health supervision for infants, children, and adolescents
that support EPSDT program requirements.
Well-Child Care: A Bright Futures Curriculum for Pediatric Providers. Ten training modules for health professionals who provide well-child care in a variety of settings, including private practice, state and local health departments, community-based MCH centers, and through Medicaid's EPSDT program. A toolkit of EPSDT resources accompanies the curriculum and includes links to state EPSDT programs.
What to Expect and When to Seek Help: Bright Futures Developmental Tools for Families and Providers. (2006). A companion referral tool helps professionals identify resources in their own communities.
- District of Columbia's HealthCheck Training and Resource Center. Online curriculum and resources for delivering and documenting EPSDT services to Medicaid-eligible children and adolescents in Washington, DC. This system was developed by the District of Columbia Department of Health Care Finance and Bright Futures at Georgetown University.
- Minnesota Department of Health: Child and Teen Checkups E-Learning Training Programs. Online training programs for health professionals and program administrators about Minnesota's EPSDT program, called Child and Teen Checkups (C&TC). Program topics: introduction to EPSDT and C&TC, hearing screening, developmental and social-emotional screening, oral health screening, vision screening, and lead screening.
- Webinar Recording and Slides:
- EPSDT Education for Providers and Advocates.This webinar was hosted by the American Academy of Pediatrics and the Georgetown Center for Children and Families, and provides detailed information to the child health community about Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, the comprehensive and guaranteed benefit for all children enrolled in the Medicaid program.
- Medical Necessity and EPSDT: Tools for Providers and Advocates. This webinar provides an overview of medical necessity definitions across the United States and best practices for ensuring children receive medically necessary services.
5. Journal Articles, Reports, Briefs, and Other Electronic Resources▼ Show
- Conduct an automated search of the MCH Digital Library's online catalog, MCHLine®, for publications, tools, and other resources about EPSDT published in the last 10 years.
The MCH Digital Library also houses the William McConway Hiscock Collection on Early and Periodic Screening, Diagnosis and Treatment, a collection of primarily reports and articles about EPSDT published between 1973 and 1982. A bibliographic index lists the documents by subject categories.
- PubMed. Citations and abstracts for biomedical articles indexed by the National Library of Medicine (NLM), with links to full-text articles when available. Conduct an automated search for articles about EPSDT. Use the filters in the left sidebar to narrow your search by publication date, among other limits.
6. Data and Statistics▼ Show
- The Centers for Medicare and Medicaid Services (CMS) collects information on state Medicaid and CHIP programs to assess the effectiveness of EPSDT. To view national and state data reports, go to the CMS overview of EPSDT and scroll down the page to "Annual EPSDT Reporting Using the Form CMS-416" (more than halfway down the page).
- To see the percentage of children enrolled in Medicaid in each state and nationally, view the table, Health Insurance Coverage of Children 0-18, in State Health Facts by the Kaiser Family Foundation (KFF). Under Data View in the left sidebar, click on Number to see the number of children enrolled in Medicaid in each state and nationally.
7. MCH Digital Library Guides on Related Topics▼ Show
- Community Services Locator: An Online Directory for Finding Community Services for Children and Families professional resource guide
- Health Insurance and Access to Care for Children and Adolescents professional resource guide, family resource brief
- Immunizations resource brief
- Lead Poisoning Prevention resource brief
- Patient Protection and Affordable Care Act (ACA) resource brief for professionals, family resource brief
- Screening resource brief
- State MCH-Medicaid Coordination Toolkit: Title V and Title XIX Interagency Agreements (IAAAs) toolkit
Resources for Families
See the MCH Digital Library family resource brief Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services in Medicaid.
Please provide feedback on this professional resource guide.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Services in Medicaid: Professional Resource Guide, 4th ed. (July 2014; Updated:
Author: Susan Brune Lorenzo, M.L.S., MCH Digital Library.
Contributor: Beth DeFrancis, M.L.S., MCH Digital Library.
Reviewers: Lauren Agoratus, M.A., parent of a child with multiple disabilities, Family Voices and Family-to-Family Health Information Resource Center at the Statewide Parent Advocacy Network of N.J.; Beth Dworetzky, M.S., Catalyst Center; Olivia K. Pickett, M.A., M.L.S., MCH Digital Library.