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KATS Network > Publications > The Buck Starts Here... > Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

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

Division of Medical Management & Quality Assurance, Department of Medicaid Services

Overview:

This program is for children from birth to age 21 who are eligible for Medicaid. Under the EPSDT program, children are checked for medical problems early. Specific tests and treatments are recommended as children grow older. The areas of health care that are checked include: preventive check-ups; growth and development assessments; vision; hearing; teeth; immunizations; and laboratory tests. Children should receive health check-ups regularly or before the following ages: 1 month; 2 months; 4 months; 6 months; 9 months; 12 months; 15 months; 18 months; 24 months; 3 years; 4 years; 5 years; 6 years; 8 years; and once a year for ages 10-20. In Kentucky, EPSDT is divided into two separate components: EPSDT Screenings and EPSDT Special Services. The EPSDT Screening Program provides routine physicals or well-child check ups for Medicaid eligible children at certain specified ages. It is considered preventive care. The EPSDT Special Services Program allows coverage for items or services which are medically necessary and which are not covered somewhere else in Medicaid. It is considered treatment.

If treatment is needed, this program provides Medicaid coverage for medically necessary special services, but may not otherwise be covered under the Kentucky Medicaid Program. Services may be preventive, diagnostic or treatment, or rehabilitative. All EPSDT special services require prior authorization.

Eligibility Requirements:

• Must be eligible for Medicaid;
• Resident of Kentucky;
• Birth to 21 years of age

AT Services Provided/Covered:

• Evaluation/Assessment
• Purchasing/Acquisition
• Selection/Design
• Training/Technical Assistance

AT Devices Provided/Covered:

• Daily Living
• Speech Communication
• Mobility, Seating and Positioning
• Vision/Hearing Equipment

Application Process:

EPSDT is part of the Medicaid program.  You must have a Medicaid card to be eligible to obtain EPSDT Services.  An individual can apply for Medicaid through the local office of the Department for Community Based Services.

Contact Information:

Department of Medicaid Services

275 East Main St.
6 C-C
Frankfort, KY 40601
(502) 564-9444
Email: dmsweb@ky.gov
Website: http://chfs.ky.gov/dms/epsdt

Additional Information:

Children who pay the KCHIP III Premium are not eligible for EPSDT Special Services or non-emergency transportation. Children who are eligible for KCHIP may receive EPSDT screenings. Children who are eligible for KCHIP may NOT receive EPSDT Special Services.

Bridges & Potholes:

Bridges

• Once Medicaid purchases a device for an individual, the device belongs to the individual. It does not remain the property of Medicaid (with some items, however, Medicaid will choose to rent rather than to purchase outright).
• Medicaid payment is payment in full. Providers may not bill both the individual and Medicaid.
• EPSDT can offer expanded services to children under age 21 that are not available to other Medicaid clients.

Potholes

• Not all devices are allowable for purchasing under Medicaid. There must be a medical need for a piece of assistive equipment and this need must be clearly demonstrated. Equipment must be prior authorized by the Department for Medicaid Services to determine medical necessity.

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