EPSDT benefit provides comprehensive screening, diagnostic, treatment and preventive health care services for individuals under the age of 21 who are enrolled in Medi-Cal.
EPSDT services are intended to prevent or minimize developmental conditions and promoten — to the maximum extent practicable — healthy development.
Among the services included under the EPSDT benefit are:
- physical therapy
- speech therapy
- occupational therapy
- vision
- dental
- hearing services
- Behavioral Health Therapy (BHT)
Based on the results of the EPSDT assessment (once found medically necessary), doctors can make appropriate referrals.
Children covered by Medicaid are more likely to be born with low birth weights, have poor health, have developmental delays or learning disorders, or have medical conditions (e.g., asthma). Medicaid helps these children and adolescents receive quality health care.
States develop their own "periodicity schedule" showing the check-ups recommended at each age. These are based on the American Academy of Pediatrics' Bright Futures guidelines, where the goal is to help health care providers offer prevention-based, family-focused and developmentally-oriented care.
The schedule helps doctors and families understand the types of care that infants, children and adolescents should get and when they should get it. They are also entitled to receive additional check-ups when a condition or problem is suspected.