Early and Periodic Screening Diagnostic and Treatment (EPSDT)

EPSDT Program

Parenting can be busy and stressful. Make sure you keep your child’s health at the top of your list! Your child can get free EPSDT visits. EPSDT stands for:

E — Early, so any problems are treated quickly
P — Periodic, to set up routine visits
S — Screening, to check for a health problem
D — Diagnosis, to find a health problem
T — Treatment, to care for a health problem

CareSource covers screening services through an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. This program covers medical and wellness exams, immunizations (shots), health education and laboratory tests for everyone eligible for Medicaid under the age of 21 years.

These exams are important to make sure that children are healthy and are developing physically and mentally. Mothers should have prenatal exams and children should have exams at the following ages:

• Birth
• 3-5 days
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 24 months
• 30 months

After that, children should have at least one exam per year.

Medically Necessary Follow-Up Care

Follow-up care includes physical, behavioral or other health problems or issues found during a screening. This could include, but is not limited to, services such as:

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

Schedule an EPSDT Preventive Health Visit With Your Child’s PCP

It is very important to get preventive checkups and screenings so your providers can find any health problems early and treat them, or make a referral to a specialist for treatment, before the problem gets more serious. Some services may require a referral from your PCP or prior authorization by CareSource. Also, for some EPSDT items or services, your provider may request prior authorization for CareSource to cover things that have limits.

As a part of EPSDT, care management services are available to all members who have special health care needs. 

To schedule an EPSDT preventive health visit, call your PCP. Make sure to ask for an EPSDT preventive health visit when you call. CareSource asks that you schedule exams for all eligible family members regularly. You should have your child’s first exam within 90 days of becoming a member.

If you would like more information about the program, please contact our Member Services department at the number below. We can help you access care, find a provider, make an appointment, find out what services are covered and which ones may need prior authorization, or arrange transportation, if needed.