Navigating Medicaid benefits can be a daunting task, especially when it comes to children.  Most of us are aware that Medicaid covers doctor’s visits, hospital stays, prescriptions, and also provides or reimburses for mileage travel to any Medicaid-approved medical visits for children who fall under certain financial guidelines.


Many parents do not know there is another program associated with Medicaid that specifically covers children to the age of 21.  Every state must adhere to the guidelines of EPSDT – Early Periodic Screening Diagnosis & Treatment, a federal program administered differently state by state and goes beyond what states may cover for adults in Medicaid. 

In general, each state must provide appropriate medical treatment for a child, as diagnosed by a physician.   Appropriate medical treatment includes treating all types of child health conditions-medical, dental, mental, developmental, and chronic conditions, regardless of whether they are pre-existing conditions or those detected outside of the EPSDT comprehensive well-child screening visit that is conducted.

Additionally, EPSDT allows for treatment and intervention services beyond what is typically covered such as:  eyeglasses, hearing aids, orthodontia, wheelchairs and prosthetic devices, occupational and physical therapy, prescribed medical formula foods, assistive communication devices, personal care, therapeutic behavioral services, and substance abuse treatment. Under federal law, EPSDT allows these additional health care services covered in the federal Medicaid program to be administered regardless of the individual state Medicaid program when these treatments are deemed medically necessary.

Thus, under EPSDT, medical necessity assures coverage not only for pre-existing illnesses or injuries, but also to prevent the development of worsening of conditions. While services will vary state-by-state, they can be available without the strict guidelines and wait times of Medicaid Waivers.  It is worth your time to check out the EPSDT services your child might be eligible for by looking online and also asking your Department of Social Services.

Moms In Motion is a Service Facilitation provider for Medicaid CD-PAS (EDCD, ID & DD Waivers) enrollees and a Case Management provider for DD Waiver enrollees. Moms In Motion strives to enhance the lives of their clients and their families, by providing support through superior service, sharing resources, and continually expanding their knowledge and networking. Visit www.momsinmotion.net for additional resources including: community partners, education, independent living, general waiver programs and information, and other services.