EPSDT Program

Questions & Answers

Ask a Question

Boulder County Public Health

3450 Broadway
Boulder, CO 80304
(303) 441-1100

You are here: Health Home > Family Health > EPSDT > Q & A about EPSDT

EPSDT: Common Questions & Answers

Q. What does EPSDT Mean?

A. EPSDT stands for Early and Periodic Screening, Diagnosis, and Treatment.

It is a federally sponsored, comprehensive health care benefits package for Medicaid-enrolled children through age 20.

It helps families access early identification and treatment of medical, dental, vision, mental health, and developmental problems for their children. All Medicaid families are encouraged to use these services. 

Q. What's the difference between EPSDT and Social Services?

A. An EPSDT outreach specialist is assigned to you based on your zip code and can help keep you up-to-date with your health care. He or she can help you with questions about Medicaid, dental needs, eye exams, and eyeglasses.

A Social Services technician is responsible for your medical coverage application and re-determination.

For more information:

• Social Services

Q. Who can use EPSDT services?

A. Persons from newborn to age 21 and pregnant women who are eligible for Medicaid and are currently on Medicaid. The EPSDT services can be used at any time, as long as the person is eligible for Medicaid and under 21.

Q. What are the EPSDT benefits?

• Assistive technology devices or services.

• Augmentative communication assessment and equipment.

• Bath equipment, such as rails or a shower chair or bench.

• Braces for the teeth or orthodontia ONLY for severe conditions, such as cleft palate.

• Care out of the state of Colorado (only if a provider is not available within the state).

• Dental care, including fillings.

• Diagnostic services, such as an EKG.

• Disposable supplies, such as diapers (after the age of 3), syringes, and catheters.

• Durable medical equipment, such as walkers, wheelchairs, and special car seats.

• Emergency room visits when prior approval is given by the PCP or covering agent.

• Extended care facilities.

• Feeding supplies, such as G-tube, J-tube, NG-tubes.

• Hearing tests and treatments, including hearing aids.

• Hospital beds, bed rails, mattresses, and pressure pads.

• Hospitalization.

• Immunizations.

• Lab tests, such as blood, skin, or urine and pap smears.

• Mental health services.

• Nurse-midwife services in pregnancy, labor, birth, and 60 days after birth.

• Orthodontics, such as braces and splints.

• Oxygen and oxygen equipment, such as nebulizers, respirators, or ventilators, and supplies.

• Physician services including specialists.

• Prenatal care.

• Prescription drugs (usually generic), not including most over- the-counter medications.

• Prosthetics such as glass eyes and artificial limbs.

• Radiology services such as x-rays.

• Rehabilitation facility care.

• Skilled nursing services and therapies.

• Suctioning equipment.

• Surgeries.

• Therapies such as occupational (OT), physical (PT), and speech therapy (SP).

• Tracheotomy and laryngectomy equipment and supplies.

• Transportation to and from medical and or dental care and may require an application. You may call Logisticare of Colorado, Medicaid non-emergency transportation broker at 1-800-390-3182 for more information.

• Vision exams and treatment, including eyeglasses.

• Well child screening visits (EPSDT screens).

• Wheelchairs (manual, electric and specialty) accessories and repairs.

Note: This list does not include everything that EPSDT might cover if it is medically necessary.

Q. What should an EPSDT health check up include?

• A complete health, nutritional, and developmental history.

• A “head to toe” unclothed physical examination.

• Health education.

• A growth and developmental check.

• Urine and blood (including lead screening tests), if needed.

• Baby shots/immunizations, as needed.

• Additional tests or exams, as needed.
  
  The person’s age determines which parts of the check up he/she will receive. Not all tests are given at every check up.
  
  Children age 1 and over should also have dental check ups which include:
   

  • Examinations

  • Cleanings

  • Fluoride treatment

  • Oral hygiene instruction as needed

Basic dental treatment (filling cavities) is covered by EPSDT, but the dentist must receive approval by Medicaid before special treatment services are given.

Q. When should EPSDT health check ups be done?

A. Medicaid check ups should begin and continue on a regular basis as recommended here:

Your provider will advise you as to when the next check up appointment should be scheduled.

Dental check ups should be done every six months. It is recommended that the initial dental check up be scheduled for your child by the age of 1.

Not finding what you are looking for? Submit your question online.