Early and Periodic Screening Diagnostic and Treatment (EPSDT)

EPSDT Program (HealthWatch®)

We cover care through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). EPSDT covers:

  • Medical and well-child exams
  • Immunizations (shots)
  • Health education
  • Laboratory tests

All Healthy Indiana Plan (HIP) members and Hoosier Healthwise (HHW) members from birth through the month of their 21st birthday are eligible for care through EPSDT.

Each child can earn rewards for visits. Learn more on our rewards page.

EPSDT exams are key to make sure that children are healthy and are developing physically and mentally. Mothers should have prenatal exams and children should have exams at:

  • Birth
  • 3-5 days
  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 24 months
  • 30 months
  • At three years old, once a year, every year

Your child should also have dental exams once a year.

Medically Necessary Follow-Up Care

EPSDT also covers medically necessary care for issues found by an exam. This could include, but is not limited to, services such as:

  • Visits with a primary medical provider (PMP), specialist, dentist, hearing, vision, and other providers to diagnose and treat problems or issues
  • Inpatient or outpatient hospital care
  • Clinic visits
  • Prescription drugs
  • Laboratory tests, including blood lead screening
  • Health education

Set Up an EPSDT Preventative Health Visit With Your Child’s PMP

Call your child’s PMP to schedule an EPSDT preventive health visit. Ask for an EPSDT visit when you call. Schedule exams for all eligible family members on a routine basis. Your child should have their first exam within 90 days of becoming a member.

You can call us if you want to learn more about EPSDT. We can help you access care, find a provider, and find out what services are covered. We can also help set up transportation. Care management is also here if you have special health care needs.

 Some services may need a referral from your PMP or prior authorization by CareSource. Learn more about prior authorization and referrals.

Please note what is a PA and what is a referral:

Prior Authorization (PA): Approval that may be needed before you get a service. It must be medically necessary for your care. Your provider will get PA for the care you need.

Referral: Your provider will ask for some services before you can get them. They will set this up and give you a note. They will tell you next steps. This can be lab tests, x-rays, or seeing specialists.

Member Services: 1-844-607-2829 (TTY: 1-800-743-3333), 8 a.m. to 8 p.m., Monday – Friday Eastern Time