EPSDT The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit was enacted in 1967 as part of the Social Security Act to ensure that medically needy/disabled children under the age of 21 have access to health care and services to identify, treat, and prevent health problems. Under the EPSDT benefit, states are required to provide comprehensive services and furnish all coverable, appropriate and medically necessary services needed to correct and ameliorate health conditions, even if such services are not included in the Medicaid state plan. Additionally, states are required to inform all Medicaid-eligible individuals under age 21 that EPSDT services are available and of the need for age- appropriate immunizations. In West Virginia, the EPSDT benefit is known as the HealthCheck Program.

Medicaid Pediatric Benefit These children are more likely to be born with low birth weights, be at risk for developmental delays, experience learning disabilities, be in poor health, and have medical conditions. As such, they have a higher need for ongoing health care and often live in families with a lack of resources to pay for it.  States are required to assess and identify problems early by checking children’s health at periodic, age-appropriate intervals. Periodic checkups must include physical, mental, developmental, dental, hearing and vision screenings, along with any others necessary to detect potential problems. Screening services include: Comprehensive health and developmental history; Comprehensive, unclothed physical exam; Appropriate immunizations; Lab tests; Health education; Vision services; Dental services; Hearing services and Other necessary health care services found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in the Medicaid state plan.

Four Perspectives A State Director’s Perspective: James E. (Jim) Jeffries, Infant, Child and Adolescent Health Division Director A Pediatrician’s Perspective: Traci Boyd Acklin, MD FAAP, President of the West Virginia Chapter of the American Academy of Pediatrics An Administrator’s Perspective: Patricia Collett, PA-C, Chief Operating Officer, Community Care of West Virginia A Parent’s Perspective: Veronica Bunch, Division of Rehabilitation Services, WV Department of Commerce- Parent