EPSDT Frequently Asked Questions

Is EPSDT different than Medicaid?

No, through EPSDT, each state’s Medicaid plan must provide to any EPSDT recipient (child or young adult) any medically necessary health care service, even if the service is not available under the State’s Medicaid plan to the rest of the Medicaid population.

 

What are the benefits of EPSDT?

Medicaid Benefits for Children (also known as EPSDT benefits) are the following:

  • Doctor Visits (Physical Examination)
  • Surgeries
  • Emergency Services
  • Hospitalization
  • Immunizations
  • Prescription Drugs
  • Diagnostic services, such as an EKG, X-ray
  • Durable Medical Equipment and Disposable Supplies (DME)
  • A growth and development check
  • Urine and blood (including lead screening) (12 and 24 months) or (36 to 72 months if not previously tested) tests, if needed
  • Mental Health Services
  • Vision Testing
  • Hearing Tests and Treatments, including hearing aids
  • Dental Services, including orthodontia (special condition)
  • Prenatal Care
  • Family Planning or abstinence information
  • Therapies such as occupational (OT), physical (PT), and speech therapy (SP)
  • Home Health Services
  • Care out of the state of Colorado (only if a provider is not available within the state)
  • Health Education
  • Outreach and Case Management Services (Healthy Communities)
  • 24/7 Medicaid Nurse Advice Line
  • Transportation to Medical Appointments
  • Note: This list does not include everything that EPSDT might cover. if it is medically necessary.

 

What is Healthy Communities?

Healthy Communities is the Case Management program for Children’s Medicaid (EPSDT) we can help you:

  • Choose a doctor, find specialists, and help schedule appointments.
  • Get to your appointments.
  • Arrange other medical needs for your family, including prenatal care.
  • Connect your child with a dentist and eye doctor.
  • Explaining what is covered by Medicaid and your managed care plan.
  • Linking you with community resources.

 

How often should I receive checkups?

 

  • Birth to one year - 6 to 8 checkups per year
  • One year to two years - 2 to 3 checkups per year, every 3 to 6 months
  • Three years to six years - 1 checkup per year
  • Seven to twenty years - 1 checkup every 1 to 2 years

 

Why are health checkup important?

Checkups or well child visits helps the child’s overall health and functioning, as health problems may be hidden. The earlier the health problems are found, the easier it is to correct them or stop them from becoming serious. Some health problems can lead to permanent disability if left untreated.

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