Policies in Practice: Integrating Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services into Clinical Care for Medicaid Beneficiaries

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits provide comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. Federal statutes and regulations require that EPSDT preventative, dental, mental, developmental, and specialty services be provided even when state Medicaid programs do not cover these same services for adults. While EPSDT was intended to expand health coverage for all low-income children, implementation has been inconsistent. Individual states are allowed to set “reasonable limits” for services covered based on certain criteria like medical necessity or utilization control, which can have the practical effect of limiting children’s access to care. Other barriers include a lack of primary health care professionals in medically underserved communities and inadequate reporting and performance standards.

EPSDT has the potential to improve health outcomes for all eligible children by ensuring they receive needed health services as early as possible in a variety of settings, including at school. This educational discussion led by national experts will introduce EPSDT, what it covers, and how it can be used to address social determinants of health in the delivery of high-quality health care.

At the conclusion of this activity, learners will be able to better:

• Identify the importance of EPSDT as it relates to appropriate screening, preventative services, and treatment services that are medically necessary.
• Integrate EPSDT to address social determinants of health in the delivery of high-quality health care.

Supported through an independent educational grant from CVS Pharmacy, Inc..

Physicians, nurses, pharmacists, pharmacy technicians, physician associates (PAs), nurse practitioners (NPs), and other applicable health care clinicians

Dr. Peek reports no financial relationships to disclose.

Dr. Hobson-Rohrer reports no financial relationships to disclose.

The following individuals have no financial relationships to disclose: 

Joshua Caballero, PharmD, BCPP, FCCP (Peer Reviewer)
Morgan Stockberger, MD (Planning Committee)
Jessica Whelan, DNP, APRN, FPMHNP-BC, RN-BC (Planning Committee)
Susan H. Yarbrough, CHCP (Planning Committee)
Sandra Caballero, PharmD (Planning Committee)
Sharon Tordoff (Planning Committee)

Call us at 877.CME.PROS (877.263.7767).

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