Introduction
This knowledge path about Early and Periodic Screening, Diagnostic,
and Treatment (EPSDT) services in Medicaid has been compiled by the MCH Library at Georgetown University. It offers a selection
of current, high-quality resources about providing and strengthening EPSDT
services. The path includes guidelines for the frequency, timing, and content
of health-promotion and disease-prevention services for infants, children,
and adolescents. Separate sections present resources for professionals (health
professionals, program administrators, policymakers, and researchers) and
for families. A special topics area lists resources about oral health services
as part of the EPSDT benefit. The knowledge path will be updated periodically.
Please note: According to the Centers for Medicare and Medicaid
Services (CMS), the "D" in "EPSDT" stands for
"Diagnostic." However,
"Diagnosis" is frequently used in the literature and
therefore appears in several publication titles below.
Overview
The Early and Periodic Screening, Diagnostic, and Treatment
(EPSDT) program provides comprehensive health services for individuals under
age 21 enrolled in Medicaid. Under federal regulations, states are given
some flexibility in determining the periodicity or timing of the health visits
and screenings, but the content of services is mandated by law to include
the following:
- Comprehensive health and developmental history, including
a developmental assessment of physical and mental health
- Comprehensive physical examination
- Immunizations, based on the current approved Advisory Committee
on Immunization Practices schedule
- Laboratory tests, including mandatory lead screening
- Vision, hearing, and dental services
- Health education and anticipatory guidance
- Diagnosis and treatment
See the Centers
for Medicare and Medicaid Services (CMS) EPSDT overview for
program details.
Data indicate, however, that many infants, children, and adolescents
do not receive the EPSDT services for which they are eligible (National
Conference of State Legislatures (NCSL), 2008). In a changing health
care and federal regulatory environment, states face challenges and opportunities
for ensuring that Medicaid-eligible infants, children, and adolescents receive
the best possible coverage; primary care provider participation and support;
care coordination and case management; and data collection, reporting, and
quality (National Academy for State Health Policy (NASHP),
2008).
Resources for Professionals
Websites
- Agency
for Healthcare Research and Quality (AHRQ). Provides evidence-based
information on health care outcomes; quality; and cost, use, and access.
Offers access to the the National Guideline Clearinghouse and
the National Quality Measures Clearinghouse. Resources
include
Child
Health Care Quality Toolbox: Measuring Performance
in Child Health Programs. Contains tips and
tools to help state and local policymakers and
program administrators evaluate Medicaid, the
Children's Health Insurance Program (CHIP), Title
V, and other health programs for children and
adolescents.
CHIPRA Children's Health Care Quality Measurement and Improvement Activities. Outlines activities
and resources related to the quality provisions
of the Children's Health Insurance Program Reauthorization
Act (CHIPRA).
U.S.
Preventive Services Task Force (USPSTF).
Presents recommendations from an independent
panel of experts in primary care and prevention
that systematically reviews the evidence of effectiveness
and develops recommendations for clinical preventive
services. The child and adolescent recommendations include
EPSDT-related services.
- American
Academy of Pediatrics (AAP). Contains
guidelines, schedules, health-education materials, and other resources
for strengthening EPSDT services. Topics pages present resources about newborn
screening, immunizations, vision
and hearing, and healthy
development. Tools include
Bright
Futures: Guidelines for Health Supervision of
Infants, Children, and Adolescents, 3rd ed.
(2007).
- Center for Children
and Families (CCF). Presents analyses
of federal policy developments and state-based initiatives affecting
the health care coverage of America's families. Includes issue briefs
and other publications developed by CCF's Strengthening
Medicaid project. CCF is based at Georgetown University's Health
Policy Institute.
- Centers
for Disease Control and Prevention (CDC). Contains
a number of resources relevant to the provision of EPSDT services,
including
CDC
Growth Charts. Contains
tools and background information for plotting
the growth of infants, children, and adolescents
from birth through age 20. Also links to interactive
training modules for health professionals using
the pediatric growth charts in clinical and public
health settings. The growth charts are available
in English, Spanish, and French.
Childhood
and Adolescent Immunization Schedules.
Contains the immunization schedule in various
formats, a catch-up schedule, education materials,
and other resources related to immunization services.
The schedule is available in English and Spanish.
Developmental
Screening. Offers
background information, screening tools, and
recommendations for developmental screening.
Hearing Loss in Children: Recommendations and Guidelines. Contains
recommendations and guidelines for newborn hearing
programs and audiologic screening for infants and children.
Newborn
Screening. Links to program information,
tools, and recommendations for newborn screening
for certain genetic, endocrine, and metabolic
disorders and hearing loss prior to discharge
from a hospital or birthing center.
Recommendations
for Blood Lead Screening of Medicaid-Eligible
Children Aged 1–5 Years: An Updated Approach
to Targeting a Group at High Risk. (2009).
[Report]. In addition, CDC's National
Center for Environmental Health offers prevention
tips, data, program information, publications,
training tools, and policy resources about lead.
Also see CDC's Pediatric
Nutrition Surveillance System (PedNSS).
- Commonwealth
Fund: Child Health/Development. Contains
program information and an extensive collection of reports that can
be used for improving EPSDT-related services. The Commonwealth Fund
is a private foundation working to improve health coverage and quality.
Also see the National Academy
for State Health Policy (NASHP) for information
about two Commonwealth-funded programs.
- Early
Childhood Learning and Knowledge Center (ECLKC): Health.
Presents resources about program planning, health and development issues,
working with families, and staff support and supervision relevant to
the provision of EPSDT services in Head Start, a national program that
serves the development needs of infants and children from birth through
age 5 and their families with low incomes through the provision of
education, health, nutrition, social, and other services. Includes
an online
directory of Head Start programs and links to state EPSDT periodicity
schedules and other resources. ECLKC is a service of the Office
of Head Start.
- Health
Resources and Services Administration/Maternal
and Child Health Bureau (MCHB). Offers
the following set of EPSDT resources:
EPSDT
and Title V Collaboration to Improve Child Health.
Provides information about EPSDT and about opportunities
for collaboration between Title V and Medicaid
to improve EPSDT services. Presents strategies
for improving EPSDT administration and performance.
Resources address systems of care issues, family
supports, data monitoring, and evolving EPSDT
policy.
State MCH-Medicaid
Coordination: A Review of Title V and Title XIX
Interagency Agreements (2nd Ed). (2008).
[Report].
Also see the Title V Information System (TVIS), the Discretionary Grant Information System (DGIS), and the MCH Library.
- Iowa
Department of Public Health: EPSDT Care for Kids. Describes
Iowa's EPSDT program for parents and health professionals. Resources
include immunization schedules, periodicity schedules, a manual for
screening centers, a care-coordination handbook, a newsletter, patient-education
materials, and additional tools and program information for professionals.
- Kaiser
Family Foundation (KFF): Medicaid/CHIP.
Contains news, publications, program information, and data about children's
health coverage and care under Medicaid, including EPSDT services.
KFF is a nonprofit, private operating foundation focusing on the major
health care issues facing the United States, as well as the U.S. role
in global health policy.
Also see statehealthfacts.org and the Medicaid
Benefits Online Database.
- Medicaid.gov. Information about Medicaid and the Children's Health Insurance Program (CHIP), including federal policy guidance, lists of pending and approved waivers, highlights of Affordable Care Act implementation efforts, and state-specific program information and data. Presents an overview of
the EPSDT program. Also includes information about Medicaid and CHIP
oral health coverage as a required component of the EPSDT benefit.
- National
Academy for State Health Policy (NASHP). Presents program information,
tools, and a wealth of other resources about child health
and development for state policymakers and program administrators,
primary care health professionals, and child and family service providers.
NASHP's initiative, Improving Early Childhood Health and Development
Using EPSDT Policy, provides support to state Medicaid EPSDT coordinators
in their efforts to improve access to and the quality of child health
and development services for children from families with low incomes.
The Assuring Better Child Health
and Development (ABCD) Program provides research and resources
to promote early childhood health and development and improve the delivery
of services, including EPSDT-related services, to children from families
with low incomes. Both programs are supported by the Commonwealth
Fund. A selection of resources includes
Managing the "T" in EPSDT Services. (2010). [Policy brief].
New
Opportunities and Continuing Challenges: A Report
from the NASHP EPSDT Forum. (2008).
Role of Children's Coverage Programs in a Changing Health Care Landscape: EPSDT,
CHIP, and Health Care Reform. (2011). [Meeting brief].
State Innovations in EPSDT. (2010). [Report].
- National
Center for Hearing Assessment and Management (NCHAM).
Contains a wealth of resources for health professionals, policymakers,
and program administrators about the implementation and improvement
of Early Hearing Detection and Intervention (EHDI) systems for infants
and children covered by EPSDT services in Medicaid and by other health
insurance programs. EHDI systems are designed to ensure that all infants
and young children with hearing loss are identified as early as possible
and provided with timely and appropriate audiological, educational,
and medical intervention. NCHAM is located at Utah
State University.
- National
Health Law Program (NHeLP): EPSDT. Presents
a collection of resources about EPSDT that include fact sheets, issue
briefs, case dockets, legal transmittals, and other resources. NHeLP
is a national public-interest law firm that aims to improve health
care for families with low incomes, minorities, the elderly, and people
with disabilities.
Additional Electronic Materials
- Alletto MM, Fraser M, Ewig B. 2009. The
Power of Prevention for Mothers and Children: The Cost Effectiveness
of Maternal and Child Health Interventions. Washington, DC: Association
of Maternal and Child Health Programs (AMCHP). [Issue brief]. Interventions include EPSDT.
- Fox HB, Limb S, McManus MA. 2007. Preliminary
Thoughts on Restructuring Medicaid to Promote Adolescent Health.
Washington, DC: National Alliance to Advance Adolescent Health. [Issue brief].
- Government
Accountability Office (GAO). 2009. Medicaid
Preventive Services: Concerted Efforts Needed to Ensure Beneficiaries
Receive Services. Washington, DC: Government Accountability Office.
[Report].
- National
Conference of State Legislatures (NCSL). 2008. Child
Health Screenings: Medicaid's Early and Periodic Screening, Diagnostic
and Treatment (EPSDT) Participation Rates, 2006. Washington, DC:
National Conference of State Legislatures (NCSL). [Map].
- Office of the Inspector General.
2010. Most
Medicaid Children in Nine States Are Not Receiving All Required Preventive
Screening Services. Washington, DC: Department
of Health and Human Services (DHHS). [Report].
- Rosenbaum S. 2008. Medicaid
Portability in the Context of Oral Health Care for Head Start-Enrolled
Children in Migrant Farmworker Families. Washington, DC: School of
Public Health and Health Services, George Washington University. [Issue brief].
- Rosenbaum S, Wilensky S, Allen K. 2008. EPSDT
at 40: Modernizing a Pediatric Health Policy to Reflect a Changing Health
Care System. Hamilton, NJ: Center for
Health Care Strategies. [Report].
- University of Oklahoma Health Sciences Center, Primary
Care Health Policy Division. 2008. Health
Care Professionals' Feedback Regarding Provision of Health Check-Ups (Early
and Periodic Screening, Diagnosis, and Treatment, EPSDT). Oklahoma
City, OK: Oklahoma Health Care Authority. [Report].
Distance Learning
- Bright
Futures at Georgetown University. Develops
Web-based curricula, training tools, and other resources for health
professionals and families for a practical developmental approach to
providing health supervision for infants, children, and adolescents
that support EPSDT program requirements. Resources and initiatives
include
District
of Columbia's HealthCheck Provider Education
System. Offers an online curriculum and resources
for delivering and documenting EPSDT services
to Medicaid-eligible children and adolescents
in Washington, DC. This system was developed
in collaboration with the District of Columbia's
Medical Assistance Administration.
Well-Child
Care: A Bright Futures Curriculum for Pediatric Providers. Presents a series of ten training modules for health professionals who provide well-child care in a variety of settings, including private practice, state and local health departments, community-based MCH centers, and through Medicaid's EPSDT program.
A toolkit of EPSDT resources accompanies
the curriculum and includes links to state EPSDT programs.
What
to Expect and When to Seek Help: Bright Futures
Developmental Tools for Families and Providers.
(2006). A companion referral
tool helps professionals identify resources
in their own communities.
Also see AAP's Bright
Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,
3rd ed. (2007).
- Enhancing
Partnerships Between Title V, Medicaid, and Local Health Departments
Through EPSDT. Contains an audio broadcast,
slides, and transcript from this September 2003 webcast that was sponsored
by MCHB. The discussion featured multiple presenters from federal,
state, and local agencies and focused on experiences and recommendations
for improving EPSDT rates through state and local partnerships.
- Managed
Care and Poor Children. Presents a learning
module about the interaction between managed care and children from
families with low incomes. It focuses on how managed care operates
to serve children and how these programs provide children’s health
services, particularly EPSDT. This module is presented by the MCH Public
Health—Social Work Leadership Training Program at the University
of North Carolina at Chapel Hill School of Social Work.
- Minnesota
Department of Health: Child and Teen Checkups Online Training Programs.
Presents online training programs for health professionals and program
administrators about Minnesota's EPSDT program. The program is a joint
venture of the Minnesota Department of Human Services and the Minnesota
Department of Health. Programs include
Developmental
and Social-Emotional Screening. (2009).
Hearing
Screening. (2003).
Oral
Health Screening. (2009).
Vision
Screening. (2009).
Databases
See the following set of MCH Library resource briefs to identify additional data and statistics, literature and research, and programs about EPSDT.
Special Topic: Oral Health
Services
- Centers
for Medicare and Medicaid Services (CMS): Dental Care for Medicaid and CHIP Enrollees.
Presents information about Medicaid and CHIP oral health coverage as a required
component of the EPSDT benefit.
- Children's
Dental Health Project (CDHP). Contains publications and program
information about children's oral health, including children's oral
health benefits under Medicaid.
- Medicaid/SCHIP
Dental Association (MSDA). Presents links to publications,
meeting materials, and other resources about state and national Medicaid
and CHIP oral health policies and practices. Includes a state Medicaid
and CHIP dental contact
list.
- National
Maternal and Child Oral Health Resource Center (OHRC).
Presents a bibliography of
materials about EPSDT oral health services, including a collection
of reports about children’s utilization of these services in
several states. Also contains guidelines, schedules, health-education
materials, and other resources for strengthening the oral health component
of EPSDT services.
- Government Accountability
Office (GAO). 2008. Medicaid:
Extent of Dental Disease in Children Has Not Decreased, and Millions
Are Estimated to Have Untreated Tooth Decay. Washington, DC: Government
Accountability Office. [Report].
- Schneider D, Rossetti J, Crall J. 2007. Assuring
Comprehensive Dental Services in Medicaid and Head Start Programs: Planning
and Implementation Considerations. Los Angeles, CA: National
Oral Health Policy Center. [Issue brief].
- Also see the Kaiser Family Foundation (KFF) issue
brief, Oral Health Coverage
and Care for Low-Income Children: The Role of Medicaid and CHIP (2009),
the National Academy for State Health Policy (NASHP) report, Effects
of Medicaid Reimbursement Rates on Access to Dental Care (2008), and
the Minnesota Department of Health Child and Teen
Checkups Online Training Program module about oral health.
Resources for Families
Related MCH Library Resources
- Community Services Locator: An Online Directory for Finding Community Services for Children and Families knowledge path
- Health Insurance and Access to Care for Children and Adolescents knowledge path
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Services in Medicaid: Knowledge Path, 3rd ed. (December 2009). (Updated:
January 2013).
Author: Susan Brune Lorenzo, M.L.S., MCH Library.
Reviewers: Lauren Agoratus, M.A., Family Voices and Family-to-Family Health Information
Resource Center at the Statewide Parent Advocacy Network of N.J.; Jennifer May,
M.P.H., M.S.W., National Academy for State Health Policy (NASHP); Olivia K. Pickett,
M.A., M.L.S., MCH Library.
Editor: Ruth Barzel, M.A., MCH Library.
