EPSDT Program (Well Child Care)
EARLY: Assessing and identifying problems early
PERIODIC: Checking children’s health at periodic, age-appropriate intervals
SCREENING: Physical, behavioral, developmental, dental, hearing, vision and other screening tests to detect potential problems
DIAGNOSTIC: Tests to follow up when a risk is identified
TREATMENT: Control, correct or reduce health
Early and Periodic Screening, Diagnosis and Treatment is a federal mandate that provides comprehensive and preventive healthcare services for children under age 21 who are enrolled in Medicaid. In Florida, the program is often called Well Child Visits.
It’s important for children to receive screenings and preventive care to avert health problems or diagnose and treat them as soon as possible. Early intervention addresses problems before they become advanced and improves long-term health outcomes.
The program covers all medically necessary services without limit to correct or ameliorate defects. This means services do not have to be considered a cure to be covered. Services that maintain or improve a child’s physical or behavioral health condition are covered. This is especially important for children with disabilities to prevent conditions from worsening, reduce pain or avert the development of additional illnesses.
Services can include:
- Physician, nurse practitioner and hospital care;
- Physical, speech/language, and occupational therapies;
- Home health services, including medical equipment, supplies, and appliances;
- Treatment for behavioral health and substance use disorders; and
- Treatment for vision, hearing and dental diseases and disorders.
The program does not cover experimental or investigational treatments. A service does not need to cure a condition to be covered. This is especially important for children with disabilities because services can prevent conditions from worsening, reduce pain, or avert the development of additional illnesses.
Screenings can include:
- Comprehensive health and developmental history
- Development and behavioral screening
- Vision, dental and hearing screening
- Lab tests, including lead toxicity
Medical necessity is determined on a case-by-case basis that accounts for the short- and long-term needs of a particular child, including his or her quality of life. Using a whole health approach, healthcare needs also include nutritional, social development, behavioral health and substance use disorders.