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What is Medicaid's EPSDT?

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is Medicaid's child health program of prevention and treatment for people under the age of 21. It includes periodic screening, vision, dental, and hearing services.

The goal of the EPSDT program is to assess a child's health needs through initial and regular examinations and evaluations, and also to assure that the health problems found are diagnosed and treated early, before they become more complicated and expensive.

The EPSDT program acknowledges that children and adolescents are at a stage in life where their brain and body are rapidly developing. Because of this, their health needs are different than that of adults.

What Benefits does the EPSDT have?

Screening services must include all of the following services:

  • Comprehensive health and developmental history – (including assessment of both physical and mental health development);
  • Comprehensive unclothed physical exam;
  • Appropriate immunizations;
  • Laboratory tests – to be performed by medical providers for particular age or population groups;
  • Lead Toxicity Screening – All children are considered at risk and must be screened;
  • Health Education;
  • Vision Services – At a minimum, include diagnosis and treatment for defects in vision, including eyeglasses;
  • Dental – At a minimum, include relief of pain and infections, restoration of teeth and maintenance of dental health. See also "The Guide to Children’s Dental Care in Medicaid;"
  • Hearing Services – At a minimum, include diagnosis and treatment for defects in hearing, including hearing aids;
  • Other Necessary Health Care – Necessary healthcare, diagnosis services, treatment, and other measures to correct or treat defects, and physical and mental illnesses and conditions discovered by the screening services. 

If a health care provider determines that a service is needed, it should be covered to the extent needed and allowed under the federal Medicaid Act.

How do I obtain EPSDT Benefits?

EPSDT is not program that needs to be applied for. It is a benefit available for all Medicaid-eligible children under the age of 21 (this includes parents who are under 21). So if your child receives health care coverage through Medicaid, then EPSDT benefits are
available. Arkansas is required to inform all eligible persons of the availability of EPSDT and immunizations. States must also offer both transportation and appointment scheduling assistance before each due date of a child’s
periodic examination.

If you have questions about EPSDT eligibility or services, you can call the Arkansas Department of Human Services, Division of Medical Services at (501) 682-8933. Some EPSDT services may require prior authorization from the Division of Medical Services (DMS). If DMS does not approve of a service, you have a right to appeal that denial.