Early Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid Services for Children

Medicaid members under the age of 21 have access to federal health care benefits called “Early and Periodic Screening, Diagnosis and Treatment Services”. This benefit makes sure that Medicaid members under 21 have access to the care they need to be as healthy as possible.

Wellness Visits (Early and Periodic Screening)

“Screening” or wellness visits are free for members under 21. These visits cover exams, vaccines (shots), and hearing and vision tests. Your provider will also watch your child’s growth and wellbeing at every visit and refer you to other treatment if needed which includes both physical and mental health.

Periodic means that these screenings are done at regular intervals. EPSDT covers all recommended screenings at ages prenatal, newborn, 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months old as well as every year from ages 3-21..

Treatment

There may be a time your child needs medical treatment for a health problem. Alliance will pay for any service that the federal Medicaid plan covers. We cannot deny the service because of a policy limit or due to the service not being part of our coverage policies, but an EPSDT review may be needed.

If you’re worried about your child’s health, don’t wait until the next visit — call the doctor or nurse right away.

Some of the services covered under Medicaid include but are not limited to:

• Dental, vision, and hearing
• Mental health
• Prescription medicines
• X-rays and labs
• Home health
• Transport to and from appointments
• Hospice (end of life) care

• If you have any questions about EPSDT, talk to your child’s primary care provider.
• You can also learn more on the NC Medicaid EPSDT webpage.
• Visit our Manage Your Health Toolkit to learn more about screenings, vaccines (shots), and other health care for your family.
• If you have any other questions, call Member and Recipient Services at 800-510-9132 Monday through Saturday, 7 a.m. to 6 p.m.