Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is a comprehensive mandatory benefits package for those under 21 who are enrolled in Medicaid. EPSDT was designed to assist families in getting early identification and treatment of medical, dental, vision, hearing, mental health, and development problems for their children. EPSDT requires that infants, children and adolescents from birth to age 20 receive periodic screening, vision, dental, and hearing services. In addition, ESPDT mandates that services under the program must include:

• Comprehensive health and developmental history, including a developmental assessment of physical and mental health.
  
• Comprehensive unclothed physical examination.
  
• Immunizations, based on the current approved Advisory Committee on Immunization Practices schedule.
  
• Laboratory tests, including mandatory lead toxicity screening.
  
• Vision services, including eyeglasses.
  
• Hearing services, including hearing aids.
  
• Dental screening, including relief of pain and infections, restoration of teeth and maintenance of dental health. Dental screening requires a direct referral to a dentist and cannot be limited to emergency care.
  
• Health education and anticipatory guidance to both parents and children.
  
• Other necessary health care, diagnosis services, and treatment to correct or ameliorate defects, and physical and mental illnesses and conditions discovered by the screening services.

EPSDT screenings are performed by, or under the supervision of, certified Medicaid physicians, dentists or other qualified health care providers.

States are free to adopt their own periodic schedules for screening, dental, vision, and hearing services. However, these schedules must meet reasonable standards of medical practice. EPSDT requires states to inform all Medicaid-eligible persons under age 21 of the services available under the program. Additionally, states are required to provide an annual report to the federal government containing the following information: (1) the number of children provided child health screening services, (2) the number of children referred for corrective treatment, (3) the number of children receiving dental services, and (4) the state's results in attaining goals set for the state.

A study by the U.S. General Accounting Office (GAO) has shown that many children do not receive the screenings they are entitled to under EPSDT. The GAO has attributed the problem to the lack of accurate reporting by the states, the lack of priority given to EPSDT by the states, and the inability to track screening for the large number of Medicaid managed care patients. The Center for Medicaid Services, the agency that administers Medicaid and EPSDT, is working on ways to increase access to the program.

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