KATS Network

“Disability Solutions through Technology”

Skip to Content | Skip to Search

Site Navigation

• Home
• About Us
• AT Resource Centers
• Services
• Publications
• Funding
• Resources
• Contact

Fact Sheet 8 - Medicaid EPSDT

Download printable version of Fact Sheet 8 (PDF)

PDF files on this page require the free Adobe Acrobat Reader (download)

Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT)

EPSDT is designed to improve primary health benefits for children with emphasis on preventive care that has been a part of the federal Medicaid program since its beginning in the late sixties. After a Medicaid review in 1989, Congress moved to increase the services of EPSDT through the Omnibus Budget Reconciliation Act. States must now cover regular and periodic exams for all eligible children under the age of 21. They must also provide any medically necessary services prescribed by the exams, even those not covered in a state's Medicaid plan. This includes many assistive devices and services for individuals that are under 21, which have been excluded under the regular Medicaid program in the past.

Note: Individuals within the manage care programs need to contact their service providers for more information.

People are just beginning to take advantage of the increased opportunities available under EPSDT. Individuals, who have a Medicaid Card, can apply for items under EPSDT through Medicaid-local offices of the state's Department of Community Based Services Permanency and Protection Unit.

It is important to get the proper documentation together when making an application through a service provider in order to avoid needless delays.

The materials that must accompany an EPSDT application are:

• A physician's order (on a prescription pad);
• A Letter of Medical Necessity from a physician, physical therapist or other qualified personnel; This letter should include:
  • A patient history,
  • A diagnosis and prognosis,
  • A medical justification for each item,
  • A description of the benefit to the patient (particularly important, should be very thorough); and
  • The length of time the patient will need the item.
• Product information: Any product information that is applicable should be provided. A description of how the particular item will fit the needs of the patient should be supplied as well as pictures, preferably with the patient using the item; and
• Prices from different manufacturers with comparable products that might fit the patient's needs.

Eligibility workers at the county offices of the Department of Community Based Services Permanency and Protection Unit inform Medicaid recipients of the EPSDT program at the time of initial eligibility and at any time when eligibility is reviewed. Durable medical equipment dealers can often be of assistance on how to access EPSDT or locate an authorized service provider. You may also direct any questions to the Department for Medicaid Services in Frankfort at (502) 564-6890.

KATS Network Coordinating Center
Charles McDowell Center
8412 Westport Road
Louisville, KY 40242
Local: (502) 429-4484
Toll Free: (800) 327-5287
Fax: (502) 429-7114

Copyright © 2008-2011 KATS Network
The contents of this website are maintained under a grant from the U.S. Department of Education, Rehabilitation Services Administration (Grant #H224A110017-11C), Assistive Technology Act of 1998, as Amended
Valid XHTML | CSS | Section 508