EPSDT Services in Medicaid
This knowledge path 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.
Resources for Professionals
- 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
See the Centers for Medicare and Medicaid Services (CMS) overview of program details.
- 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
2. EPSDT Policy
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 and Title V Collaboration to Improve Child Health. 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
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
include benefits, cost sharing, delivery systems, eligibility, financing
reimbursement, managed care, outreach and enrollment, and quality of
Academy for State Health Policy (NASHP): Resources to Improve Medicaid for Children and Adolescents.
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.
Health Law Program (NHeLP): Early and Periodic Screening, Diagnostic and
Treatment. 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
- American Academy of Pediatrics (AAP), Committee on Child Health Financing.
Policy Statement. Pediatrics 116(1): 274-280. Reaffirmed
- Rosenbaum S, Wilensky S, Allen K. 2008. EPSDT
at 40: Modernizing a Pediatric Health Policy to Reflect a Changing
Health Care System. Hamilton, NJ: Center for Health Care Strategies.
3. Tools for Providing EPSDT Services
- 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
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.
Schedules. Schedules and tracking tools for
health professionals and families. Schedules
in English and Spanish and in various
about childhood lead exposure and prevention.
Includes guidelines for
screening and case management.
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.
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
age 5 and their families with low incomes through the provision of
education, health, nutrition, social, and other services. Includes
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
health professionals. Includes contact information for vision care financial
assistance and information about school requirements for children's vision
in each state.
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
other resources for strengthening the oral health component of
- 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.
Department of Medical Assistance Services: Maternal and Child Health
Programs. Select EPSDT from the list of programs and scroll
down on the page to find forms, periodicity charts, manuals, and
other documents about EPSDT services, such as behavioral therapy,
private duty nursing, audiology and hearing aids, assistive technology,
and medical infant formula and nutritional supplements. Includes
EPSDT brochures and newsletters for families in English and Spanish.
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.
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.
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.
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.
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
vision screening, and lead screening.
5. Journal Articles, Reports, Briefs, and Other Electronic Resources
- 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
- 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 EPSDT Data (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. NCEMCH Guides on Related Topics
Resources for Families
See NCEMCH family resource
brief Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services in Medicaid.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Services in Medicaid: Knowledge Path, 4th ed. (July 2014). (Updated:
Author: Susan Brune Lorenzo, M.L.S., NCEMCH.
Contributor: Beth DeFrancis, M.L.S., NCEMCH.
Reviewers: Lauren Agoratus, M.A., parent of a child with multiple disabilities,
Family Voices and Family-to-Family Health Information Resource Center at the
Advocacy Network of N.J.; Beth Dworetzky, M.S., Catalyst Center; Olivia K. Pickett,