Early Periodic Screening Diagnosis and Treatment
What is EPSDT?
EPSDT is a special program for people receiving Medicaid and are pregnant or under 21 years of age. EPSDT detects and treats health care problems early through:
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regular medical, dental, vision, and hearing check ups
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in-depth diagnosis of problems
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treatment of dental, eye, hearing, and other medical problems.
Who can use EPSDT services?
Persons from newborn to age 21 who are eligible for Medicaid, and have a current Medicaid card. The EPSDT services can be used at any time as long as the person is eligible for Medicaid and under 21.
Why are Health check ups important?
- Health problems may be hidden.
- The earlier health problems are found, the easier it is to correct them or stop them from becoming serious.
- Some health problems can lead to permanent disability if left untreated.
What should an EPSDT health check up include?
- A complete health, nutritional, and developmental history
- A "head to toe" unclothed physical examination
- Health education
- A growth and developmental check
- Urine and blood (including lead screening tests), if needed
- Baby shots/immunizations, as needed
- Additional tests or exams, as needed
The person's age determines which parts of the check up he/she will receive. Not all tests are given at every check up.
Children age 1 and over should also have dental check ups which include:
- Examination
- Cleaning
- Fluoride treatment
- Oral hygiene instruction as needed
Basic dental treatment (filling cavities) is covered by EPSDT, but the dentist must receive approval by Medicaid before special treatment services are given.
When should EPSDT health check ups be done?
Medicaid check ups should begin early and continue on a regular basis as recommended here:
| Age | Check Ups |
|
birth to one year |
6 to 8 check ups per year |
|
one year to two years |
2 to 3 check ups per year |
|
three year to six year |
1 check up every year |
|
seven years to twenty-one years |
1 check up every year |
Your doctor or clinic will advise you as to when the next check up appointment should be scheduled.
Dental check ups should be done every six months. It is recommended that the initial dental check up be scheduled for your child by age 1. If you are using EPSDT services, you are also eligible for Medicaid benefits as recommended by your Primary Care Physician or HMO.
Who will pay for EPSDT health check-ups?
EPSDT/Medicaid will pay for these health check ups at no cost. It will also pay for treatment of dental, vision, hearing, and other medical problems. If a problem is found which is not covered by Medicaid, the EPSDT case manager will help find a program which will provide treatment at little or no cost.
Where are the EPSDT health check ups offered?
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Contact your Primary Care Physician/HMO listed on your Medicaid card. The physician will perform the health check up or refer you to a doctor or health clinic who accepts Medicaid.
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Participating eye doctor, optician and dental offices/clinics
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Participating health agency clinics if referral is made by the Primary Care Physician
Your local EPSDT case manager can give you the names and addresses of physicians, eye doctors, and dentists in your area who provide these services. The outreach coordinator can also help you:
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Find doctors, specialists, and help schedule appointments
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Find a dentist and eye doctor for those under 21 years of age
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Find other resources such as food, clothing banks, the WIC program, etc...
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Help you understand the services covered by Medicaid and your health plan
Who do I Contact for more information?
(719) 275-8350 or epsdt@uaacog.com