EPSDT

WHAT IS EPSDT?

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is known as Health Check in North Carolina.

Medicaid pays for certain regular screening, vision, dental and hearing services for children and youth under age 21. Medicaid will pay for these services if they are medically necessary to correct or “ameliorate” a physical or mental illness, or a condition identified through screening. Ameliorate means:

To improve or keep the member’s health in the best condition possible;
To take care of a health problem to keep it from getting worse; or ·
To prevent more health problems.

The services Medicaid will pay for:

Must be medical;
Must involve medically-accepted procedures or treatments;
Must be safe and effective; and
Cannot be experimental or investigational.

EPSDT includes:

Periodic screening services
Vision services
Dental services
Hearing services
Rehabilitative services for intellectual/developmental disabilities (I/DD)
Mental health and substance use disorder services
Medical and adaptive equipment
Transportation
In-home nursing
Personal care
Specialized therapies
Out-of-home residential, facility, and hospital services
Other medically necessary health care

EPSDT also offers:

No waiting list for services.
No cap on the total cost of services.
No upper limit on the number of hours.
No limit on the number of EPSDT visits to a physician, therapist, dentist, or other licensed clinicians.
No set list that specifies when or what EPSDT services or equipment may be covered.
No copayment or other cost to the NC Medicaid member.
No copayment or other costs to the recipient of State-Funded services.
Coverage for services that are never covered for people older than age 21.
Coverage for services not listed in the North Carolina State Medicaid Plan.
No set list that specifies what EPSDT services or equipment may be covered.

Questions about EPSDT? Call Sandhills Center Member & Recipient Services: 1-800-256-2452 (TTY: 1-866-518-6778).