Early
and Periodic Screening, Diagnostic, and Treatment
(EPSDT) Services in Medicaid
Knowledge Path
Knowledge Path Table of Contents
Introduction- Websites
- Additional Electronic Materials
- Distance Learning
- Databases: Data, Literature and Research, and Programs
Special Topic: Oral Health Services
Please provide feedback on this knowledge path.
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.
Related knowledge
paths:
Health
Insurance and Access to Care for Children and Adolescents.
Community
Services Locator: An Online Directory for Finding Community
Services for Children and Families
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.
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 fact sheet 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).
- 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).
- Centers
for Medicare and Medicaid Services (CMS). Contains general
information about Medicaid with
links to eligibility
information. Offers an overview of
the EPSDT program and a fact
sheet that describes the required services for EPSDT within each
state's Medicaid program. Provides an overview of
state Medicaid agency responsibilities regarding EPSDT with links to
the annual EPSDT report, reporting instructions, and state and national
summaries from the reports. Also includes information about Medicaid
oral health coverage as a required component of the EPSDT benefit.
- 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.
Recent publications include
Improving Care Coordination, Case Management, and Linkages to Service for Young Children: Opportunities for States. (2009). [Report].
Medicaid and CHIP Strategies for Improving Child Health. (2009). [Report and charts].
North Carolina's ABCD Program: Using Community Care Networks to Improve the Delivery of Childhood Developmental Screening and Referral to Early Intervention Services. (2009). [Issue brief].
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.
HRSA Medicaid Primer. Offers a set of fact sheets to assist state and local health officials in understanding how Medicaid works and how it can ensure access to health services for underserved populations, including eligible infants, children, and adolescents.
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. Publications include
Aging Out of Early and Periodic Screening, Diagnostic and Treatment (EPSDT): Issues for Young Adults with Disabilities. (2007). [Issue brief].
Emerging Health Information Technology for Children in Medicaid and SCHIP Programs. (2008). [Report].
Health Coverage of Children: The Role of Medicaid and SCHIP. (2008). [Fact sheet].
Impact of Medicaid and SCHIP on Low-Income Children's Health. (2009). [Issue brief].
Medicaid Resource Book. (2003). This comprehensive reference tool describes Medicaid eligibility, benefits, financing, and administration and includes discussion of EPSDT, among other components of the Medicaid program.
Also see statehealthfacts.org and the Medicaid Benefits Online Database.
- 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 recent 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). This brief summarizes
effective and efficient interventions provided by state MCH programs
to improve the lives of mothers, children, and families, and that merit
increased national investment. 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. This
issue brief proposes an enhanced set of health-promotion and primary
care benefits designed specifically for adolescents that can be offered
through EPSDT or as an alternative benefit package under the Deficit
Reduction Act.
- Government
Accountability Office (GAO). 2009. Medicaid
Preventive Services: Concerted Efforts Needed to Ensure Beneficiaries
Receive Services. Washington, DC: Government Accountability Office.
This report examines the provision of preventive services for children
and adults in the Medicaid program, including the extent to which state
Medicaid programs monitor and promote EPSDT services for children.
- 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). This map shows the
percentage of eligible children who received at least one EPSDT screening
(well-child) visit in the year in each state.
- 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). This report describes the extent
to which children in nine states received EPSDT screenings. The report
also describes state efforts to increase EPSDT-eligible children’s
participation in EPSDT screenings and the completeness of EPSDT medical
screenings.
- 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. This
analysis examines opportunities and challenges in addressing Medicaid
eligibility and enrollment for children in Migrant and Seasonal Head
Start programs.
- 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. This report examines the continuing role
of EPSDT in a changing health care system. The report presents an overview
of EPSDT along with an explanation of the Deficit Reduction Act as it
relates to EPSDT benefits. The report describes current state practices
in implementing EPSDT in managed care, identifies promising approaches
to EPSDT modernization that take into account Medicaid's evolution as
a purchaser of health benefits and service products, and makes recommendations
for improving EPSDT administration and coordination between EPSDT and
early childhood development and child care programs.
- 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. This report describes the results
of a survey of Oklahoma primary care health professionals regarding EPSDT
health visits, particularly developmental screening.
- 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 Providers in MCH and Medicaid/EPSDT Settings. Presents a training curriculum for health professionals who provide well-child care for infants, children, and adolescents, especially those served by state MCH programs or by Medicaid's EPSDT program. A toolkit accompanies the curriculum.
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).
The databases listed below are excellent tools for identifying data, additional literature and research, and programs about EPSDT. Many of the entries below contain tips on how to use the databases efficiently. Please note that databases vary in how terms should be entered; for example, some require quotation marks and others don't. Enter search phrases as shown in bold below.
- National
Quality Measures Clearinghouse™ (NQMC). Contains
evidence-based health-care-quality-measures and measure sets for physicians,
hospitals, and health plans to evaluate and improve the quality of
health care for consumers. Search for measures that target a particular
disease/condition, treatment/intervention, age range, vulnerable population,
setting of care, or contributing organization. To identify EPSDT-related
measures, enter Medicaid AND (infants OR children OR adolescents) in
the search box. The database is sponsored by the Agency
for Healthcare Research and Quality (AHRQ).
- Pediatric
Nutrition Surveillance System (PedNSS). Monitors the nutritional
status of children from birth to age 5 in federally funded MCH programs,
such as Medicaid. Data on birthweight, short stature, underweight,
overweight, anemia, breastfeeding, and health-risk behaviors are collected
for those who visit public health clinics for routine care, nutrition
education, and supplemental food. PedNSS is administered by the Centers
for Disease Control and Prevention (CDC).
- statehealthfacts.org.
Contains state-level data on demographics, health status, health coverage
and the uninsured, Medicaid and CHIP, health costs and budgets, Medicare,
managed care and health insurance, providers and service use, minority
health, women's health, and HIV/AIDS. Information is displayed as bar graphs,
tables, or color-coded maps. View individual state profiles or compare
data for all states by category. Click on the Medicaid and CHIP category
for information such as enrollment, eligibility requirements, managed care
participation, spending and federal matching amounts, and enrollment practices.
statehealthfacts.org is a project of the Kaiser Family Foundation.
Kaiser also offers customizable state
Medicaid fact sheets. For detailed information about the Medicaid benefit
packages in each state, see Kaiser's Medicaid
Benefits Online Database.
- Title
V Information System (TVIS). Contains data from annual Title
V Block Grant applications and reports submitted by all 59 U.S. states
and jurisdictions. To identify EPSDT-related services provided by states,
select Program
Data for the Most Recent Year. Select one of several options under
Individuals Served and Health Screening. Title V IS is a service of
the Maternal and Child Health Bureau (MCHB). Also
see MCHB's Discretionary Grant Information System (DGIS).
- MCH Library at the National
Center for Education in Maternal and Child Health (NCEMCH),
Georgetown University. Maintains several databases to collect, manage,
and disseminate knowledge about MCH, with special emphasis on knowledge
gained from initiatives and programs supported by the Maternal
and Child Health Bureau (MCHB). The library's bibliographic database
is
MCHLine®. Comprises an online catalog of materials in the MCH Library, including reports and documents about EPSDT from the 1970s to the present. Search the database by entering epsdt in the keyword field of the search form. To limit your search, add a publication date range and/or additional keywords (e.g., "head start"). Also see selections of recent library items about screening in the following two bibliographies: (1) child developmental screening and (2) newborn screening. The MCH Library also holds the William McConway Hiscock Collection, an uncataloged set of materials on EPSDT containing over 150 items, primarily reports and articles published in the 1970s and early 1980s. For more information about the Hiscock collection or to view the materials in it, contact the library.
Also see the library's organizations and programs databases.
- National
Guideline Clearinghouse (NGC). Contains
evidence-based clinical practice guidelines and related materials for
health professionals. Identify guidelines by entering Medicaid AND
(infants OR children OR adolescents) in the Search field. The database
is an initiative of the Agency
for Healthcare Research and Quality (AHRQ).
- PubMed.
Contains more than 20 million citations for biomedical articles from MEDLINE
and life science journals. Citations may include links to full-text articles
from PubMed Central or publisher websites. To identify citations on the
topic, enter the term epsdt in the search box. To narrow your search,
click on Limits and enter a publication date and/or use the MeSH
(Medical Subject Headings) database to identify additional search terms.
PubMed is a service of the National Library
of Medicine (NLM).
- State
Coverage Initiatives (SCI): State Profiles.
Click on a state to find out about the state's health coverage programs
and coverage strategies.
- Discretionary
Grant Information System (DGIS). Contains information
for more than 900 grants issued by the Maternal and
Child Health Bureau (MCHB). Search the abstracts of MCHB discretionary
grants by entering epsdt in the Search Word or Phrase
field. Click on Search to get your results. To find products and publications
produced by MCHB training grantees, select Program Data, Training,
and Search Products and Publications. Type epsdt in
the search field and click on Search to get your results.
- MCH Library at the National
Center for Education in Maternal and Child Health (NCEMCH),
Georgetown University. Maintains two databases to identify organizations
and programs that address Medicaid and EPSDT:
MCH Organizations Database. Lists over 2,000 government, professional, and voluntary organizations involved in MCH activities, primarily at a national level. To identify organizations, type Medicaid in the keyword field of the database search form. Click on Search to get your results.
MCH Projects Database. Comprises an online catalog of projects funded by the Maternal and Child Health Bureau (MCHB) through October 1, 2004. To identify projects, enter epsdt in the abstract field of the database search form. Click on Search to get your results. See MCHB's Discretionary Grant Information System (DGIS) for information on projects funded after October 1, 2004.
- Medicaid
Benefits. Provides information about benefits covered,
populations served, and the limitations, co-payments, and reimbursement
policies that apply to Medicaid benefits for all 50 states, the District
of Columbia, and U.S. territories. To learn how EPSDT services are
displayed in this database, see Benefits
by Service: Early and Periodic Screening, Diagnosis and Treatment.
This database is a service of the Kaiser Family Foundation
(KFF) and the National Conference
of State Legislatures (NCSL).
Special Topic: Oral Health Services
- Centers
for Medicare and Medicaid Services (CMS): Medicaid Dental Coverage.
Presents information about Medicaid oral health coverage as a required
component of the EPSDT benefit. Publications include
Policy Issues in the Delivery of Dental Services to Medicaid Children and Their Families. (2008). [Guidelines].
State Reports 2008. (2009). This collection of reports reviews state EPSDT oral health services.
- 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. This report presents information from national
health surveys on key indicators of the oral health status of children
in Medicaid, specifically, the rate of oral disease and receipt of oral
health care, and changes in these indicators over time.
- 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. This issue brief addresses efforts to
improve access to oral health services for children enrolled in Medicaid
and Head Start. The brief focuses on service delivery arrangements that
include screening and prevention services provided by non-dentists outside
traditional oral health care delivery settings.
- 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.
- See the MCH Library family resource brief Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services in Medicaid.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Services in Medicaid: Knowledge Path, 3rd ed. (December 2009). (Updated:
September 2011).
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.
