Early and Periodic Screening Diagnostic and Treatment program (EPSDT)
Overview of EPSDT
Children and youth age 20 and under are covered by the Early and Periodic Screening Diagnostic and Treatment program, also known as EPSDT.
- Well-child screenings
- Vision Exams
- Dental Visits
- Lab testing
- Home health services
EPSDT allows a child to receive anything medically necessary, even if it is not covered by State Plan and Medicaid. A good example is a circumcision benefit. Medicaid does not cover this service on a routine basis. However, the procedure will be covered if the child has medical reasons why this procedure must be completed.
There are some parameters of EPSDT:
- the treatment cannot be experimental or investigational
- services must be within the normal course and duration of treatment
- services cannot be for the convenience of the caregiver or provider
- the service must be the most effective option available
If you feel that a service or item was not approved and it fits with the EPSDT exception process, please appeal the decision. The appeals process will be detailed on the back of the denial notice. This process is easy and you should not be intimidated by appearing before a judge. Please make sure you read the appeal process and that you meet the timelines outlined in the process.
EPSDT is very important because half of all Medicaid enrollees in the U.S. are children, and this program is designed to enhance their primary care with an emphasis on prevention, early diagnosis and timely treatment. For more information about Colorado’s EPSDT program, please visit the Health Care Policy and Financing website.