Healing families. Strengthening communities.

EPSDT Funding

EPSDT is designed to improve primary health benefits for children with emphasis on preventive care.

EPSDT has always been part of the Medicaid regulations; however, many states were slow to implement its provisions. To correct this problem, Congress amended the Medicaid statute in 1989 to make EPSDT a statutory requirement. (See the Omnibus Budget Reconciliation Act of 1989). Today, EPSDT is the most comprehensive child health program in either the public or private sector.

As the program name suggests, EPSDT eligible children must “periodically” receive thorough assessments (“screening”) of their overall physical and mental health, and their growth and development. If, as a result of this screening, any medical service is identified which would promote a child’s health, prevent disability, or help a child achieve a maximum level of functioning, then Medicaid should probably pay for this service. Any service that could be provided under federal Medicaid law must be provided under EPSDT.

Screenings or well-child checkups are the foundation of the EPSDT program. By statute, the state “must provide or arrange for” four separate screens: medical, vision, hearing, and dental. This means that the state must assure that children receive the check-ups required by EPSDT. Screenings must include the following components:

  • Comprehensive health and developmental history, including assessment of both physical and mental health development;
  • Comprehensive unclothed physical exam;
  • Appropriate immunizations according to age and health history;
  • Laboratory tests including a lead toxicity screening;
  • Health Education, including anticipatory guidance;
  • Vision and hearing screens; and
  • Dental screens
  • Medical and remedial care recognized under state law and furnished by licensed practitioners practicing within the scope of their practice (i.e. psychologists, social workers, audiologists)
  • Home health services
  • Case management (defined as any services that will assist individuals to gain access to needed medical, educational, social, and other services)

For further research:

State-by-state fiscal impact of EPSDT: http://www.aphsa.org/