Toward a Healthy Future: Medicaid Early and Periodic Screening, Diagnostic and Treatment Services For Poor Children and Youth

Introduction

Part I: The Need for Medicaid and EPSDT
A. 	Many children are poor and uninsured	
B. 	Medicaid is a primary source of insurance for children	
C. 	The importance of the Medicaid EPSDT service	
D.	The  effectiveness of EPSDT	
E.	An EPSDT report card	

Part II: Medicaid Overview
A.	Medicaid background	
B.	Eligibility	
1.  Fitting into a group
2.  Limited income and resources
3.  Residency
4.  Citizenship/immigration Status
C. 	Services
D.  Administration

Part III: Legal Requirements for EPSDT
A.	EPSDT background	
B.	Requirements for outreach and informing	
C.	Requirements for screening services	
1.  Medical screens
a.  Comprehensive health and developmental history
b.  Unclothed physical exam
c.  Laboratory tests
d.  Nutritional assessment
e.  Immunizations
f.  Health education
2.  Hearing screens
3.  Vision screens
4.  Dental screens
D.	Requirements for periodicity of screens	
E.	Requirements for interperiodic screens	
F.	Requirements for diagnostic and treatment services	
1.  Scope of benefits
2.  Timely treatment
3.  Coverage standards
4.  Other treatment topics
G.	Provider participation	
H.	Cost-sharing
I.	Reporting on child health	

Part IV: Common Problems/Suggested Solutions
A.	Lack of outreach and informing	
B.	Lack of transportation	
C.	Provider shortages	
D.	Denials of services by managed care organizations	

Notes

											
Appendix A: Legislative History to EPSDT

 
Appendix B: Age-appropriate Screening Forms

Appendix C: AAP Periodicity Recommendations v. States’ Periodicity Schedules, FY 1999						
 
Appendix D: Scope of Medicaid Benefits