Learning More about EPSDT


Let’s talk about EPSDT and what it means for you. Whether you are someone wondering if it’s the right thing for you, or you utilize it and want to know more, we have the information you need.

Here is our full guide on EPSDT, starting with what it actually is.

What is EPSDT?

EPSDT stands for Early and Periodic Screening, Diagnostic and Treatment. This benefit provides children under the age of 21 (who are enrolled in Medicaid) with comprehensive and preventative health care services. It is vitally important for making sure that children and young adults receive proper dental, developmental, preventive, mental health, and specialty services.

So what does each word in the title stand for? Here’s the breakdown:

  • Early: Assessing and identifying problems early on.
  • Periodic: Ensuring that children’s health is checked periodically at age-appropriate intervals.
  • Screening: Offering screening tests for potential problems such as hearing, vision, dental, mental, and developmental disabilities.
  • Diagnostic: Performing diagnostic tests to follow up on risks that are previously identified with screenings.
  • Treatment: Correcting, controlling, or reducing the health problems found.

Are you Eligible for EPSDT?

Now that you know what EPSDT is, let’s talk about whether or not you are eligible for it.

As stated before, these benefits are for those under the age of 21, and those that are already eligible for Medicaid.

To find out if you are eligible for Medicaid through your disability, check our new guide.

For eligibility in other ways besides a disability, check out this information from Medicaid.


Getting Started with EPSDT

Once you have determined that you are eligible for Medicaid, your primary care physician (or the nurse practitioner or physician’s assistant) will have to fill out a DMAS-7. Then you will want to make an appointment with your doctor to discuss the form, which includes information such as:

  • Activities of daily living (ADLs/IADLs) including bathing, eating/feeding, transferring, toileting, meal preparation, ambulation, grocery shopping, house cleaning, and transportation.
  • Medical diagnoses

EPSDT requires 3/10 ADL tasks based on your impairment because it applies to your ability to perform these tasks and how much support they require. It will over behavioral support (as it applies to the frequency of your behaviors and the intervention required by caregivers) and additional supports such as:

Self-administration of medications

Medical support

Assistance with skilled tasks (dressing changes, vital signs, etc)

Assistive devices for communication, mobility, sensory, etc.

It will also cover assistive technology, private duty nursing, hearing aids, personal care, nutritional supplements, and behavioral therapy (including ABA).

Services Offered in EPSDT

Virginia’s Department of Medical Assistance Services is required to provide you with comprehensive services and all medically necessary services needed to correct or reduce health conditions covered by Medicaid.

The following diagnostic, screening and treatment services are covered by EPSDT:

  • Screening for health and development history
  • Immunizations
  • Physical exams
  • Lab tests
  • Vision/hearing
  • Health education
  • Dental
  • Developmental and behavioral screening – this is incredibly vital during early childhood to identify possible delays in development and/or growth. If it’s caught early, steps to address issues can be much more effective. Those enrolled in Medicaid are required to get this screening, and it’s covered for those with CHIP as well.

Learn More About EPSDT with At Home Your Way

Looking to learn more about EPSDT and other VA Medicaid waivers? Look no further than At Home Your Way!

Reach out to us directly or check out our blog and searchable resource list for more information.

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