FEBRUARY2003

Question: What health care services are available under the Early Periodic Screening, Diagnosis and Treatment program? Are mental health and substance abuse services available?

Answer: Health care services available through the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program are extremely comprehensive and consists of two mutually supportive operational components:

• Ensuring the availability and accessibility of required health care resources 

• Assisting Medicaid enrollees and their parents or caregivers to effectively use them

The goal of the EPSDT program is to ensure that health, including mental health, problems are either prevented or diagnosed and treated early, before they become more complex.

The Medicaid statute, regulation, and guidelines require that the following services be provided:

• A comprehensive health and developmental history, including the assessment of both physical and mental health development 

• A comprehensive physical examination

• Appropriate immunizations according to the combined schedule of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, the American Academy of Pediatrics (AAP), and the American Academy of Family Practitioners (AAFP) 

• Laboratory tests

• Health education and anticipatory guidance

• Vision services including eyeglasses

• Hearing services including hearing aids

• Dental services 

• Other such necessary health care, diagnostic, and treatment services and other measures to correct or ameliorate health problems, both physical and mental health conditions, discovered by the screening services, whether or not such services are covered under the State Plan.

These services must meet "reasonable standards of medical and dental practice, as determined by the State in consultation with recognized medical and dental organizations involved in child health care." Examples of these groups include the AAP and the American Dental Association. Subspecialty groups that could address the mental health component include but are not limited to the American Academy of Child and Adolescent Psychiatry and the American Psychological Association. Ideally, these groups should work together to develop a comprehensive package of services for children and adolescents.