Medicaid’s Health Care Benefit Package for Children: EPSDT

5/2/2014

Since 1967, Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program has offered comprehensive services to eligible children to discover and treat, as early as possible, any physical, mental, developmental, dental, hearing and vision problems. The program covers Early care, starting at birth; Periodic health checks at age-appropriate intervals; Screening tests to detect potential physical, mental, developmental, dental, hearing, vision and other problems; Diagnostic tests, to follow up if a risk is identified; and medically necessary Treatment of problems.

Despite this benefit, many children enrolled in Medicaid still do not receive recommended screenings or follow-up care. In FY 2012, more than 37 million children (ages 1 to 20 years old) were eligible for EPSDT services, but only about 60 percent received them. State Medicaid programs are required to cover screenings and services deemed medically necessary, but have some flexibility in establishing how often they are offered. States must also make efforts to inform families of the services, enroll eligible children, and provide transportation to care when necessary.

States have made various efforts to reduce barriers children may face to receiving screenings, treatments and follow-up care. Examples include increasing Medicaid reimbursement rates, ensuring an adequate number of medical practitioners in underserved areas, and educating eligible families about the availability of these Medicaid services.

Sources: Centers for Medicare and Medicaid Services, 2014; Health Resources and Services Administration, 2013.

Medicaid's Child Health Screening Rates | Fiscal Year 2012

United State map of Medicaid's Child Health Screening Rates, FY 2012

* States that meet the CMS recommended rate (80%)
Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) participant rate is the percentage of eligible children who received at least one screening visit.
Sources:  Form CMS-416, Centers for Medicare and Medicaid Services (CMS), 2013; National Conference of State Legislatures, 2014.

Additional Resources

This webpage was adapted from an NCSL postcard published in May 2014.