Written by: Vanessa Jerusalimiec (*Amsive Digital) | Reviewed by: Shelley Wyant | *MHP partners with Amsive Digital on news content
Understanding EPSDT: A Guide for Michigan Medicaid Families
Parents know that early intervention and preventive care are an important part of the health and well-being of children and adolescents. Families in Michigan who are enrolled in Medicaid have access to a program that can help: the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This program offers essential services to address children’s health care needs and help parents make sure their children and teens are accessing the right care.
EPSDT provides a full range of preventive and treatment services to support children’s growth and development. The program also offers screenings to detect potential health issues early on and provide necessary care. EPSDT helps Michigan families make sure their children and teens receive regular check-ups, immunizations, dental care and other health services to keep them healthy.
What is EPSDT?
EPSDT, or Early and Periodic Screening, Diagnostic and Treatment, is a Medicaid benefit that provides health care services to Medicaid-eligible individuals under the age of 21. It offers a number of benefits beyond what standard Medicaid typically covers. The purpose of EPSDT is to provide regular screenings and any necessary diagnostic or treatment services as children grow.
EPSDT offers preventive and diagnostic support with a focus on early detection and treatment. For children, it’s important to identify and address health issues before they become significant problems, and that’s where EPSDT comes in. By catching health issues early on, EPSDT supports healthy development and helps children and teens achieve their full potential. Health care services include preventive care, checkups, diagnoses and treatments to address children’s health needs at every stage of development.
Key Components of EPSDT
EPSDT includes three primary components: Screening, Diagnostic Services and Treatment:
1. Screening
Screening services are a key component of EPSDT. Screenings can provide an early assessment of a child’s physical and mental health. Regular screenings help identify potential health problems early, which is important for effective intervention. EPSDT screening services include:
- Comprehensive Physical Exams: Regular check-ups are covered by EPSDT. These physical exams with a health care provider help monitor a child’s growth and development, assessing for potential issues that may need further evaluation.
- Vision, Hearing and Dental Screenings: These screenings help detect sensory and oral health problems that could impact a child’s quality of life. Vision and hearing problems can also impact learning abilities, so screenings and early treatment can have a major impact on growth and development.
- Developmental and Behavioral Assessments: Screenings for developmental milestones and behavioral health help make sure that a child’s mental and emotional well-being is being addressed.
The EPSDT program follows recommended guidelines for preventive health visits, including specific screenings and tests at various stages of a child’s development.
2. Diagnostic Services
If a screening points to any concerns, EPSDT covers diagnostic services to find out more about the health issue. Diagnostic services may include laboratory tests, imaging studies, and specialist consultations to identify any underlying conditions or health concerns. Children and adolescents will receive necessary diagnostic testing and medical evaluations right away so any issues can be effectively managed.
3. Treatment Services
Once a diagnosis is made, EPSDT provides treatment coverage. Your child will get coverage for any treatments deemed medically necessary to address their health condition. Treatment services cover a wide range of health care needs, including but not limited to:
- Medications: Prescriptions that may be needed to manage or treat a condition.
- Therapies: Physical, occupational and speech therapies to support children with developmental or physical challenges.
- Surgical Interventions: EPSDT also covers surgeries and other medical procedures when necessary.
Under EPSDT, Medicaid will provide all necessary services to diagnose and treat health issues as early as possible, maximizing the potential for positive outcomes.
Coverage for Michigan Medicaid Families
In Michigan, EPSDT provides a comprehensive set of services for children enrolled in Medicaid, covering everything from preventive care to specialized treatments. Here are some of the essential health care services provided under EPSDT for Michigan Medicaid families:
- Immunizations: Vaccinations are a critical part of preventive health care, protecting children from illnesses like measles, mumps, and the flu. EPSDT covers all recommended vaccinations as outlined by the Centers for Disease Control and Prevention (CDC) guidelines.
- Wellness Visits: Routine check-ups are part of EPSDT. During wellness visits, your health care team will monitor growth, assess developmental milestones, and provide counseling on nutrition, exercise and more. These visits are an opportunity for providers to address any concerns you might have about your child’s overall health and well-being.
- Dental Care: EPSDT ensures that children have access to regular dental exams, cleanings, and treatments such as sealants and fillings. This dental care benefit helps your children maintain good oral health.
If a service or treatment is considered necessary for a child’s health but is not typically covered under Michigan Medicaid, EPSDT can often cover the treatment. This means that every child gets the care they need, regardless of whether it falls within standard Medicaid coverage.
Accessing EPSDT Services in Michigan
Accessing EPSDT services in Michigan is straightforward, with resources available to help families schedule and navigate health care services for their children. Here’s how Michigan Medicaid families can use EPSDT services:
- Scheduling Screenings: Parents and guardians can schedule EPSDT screenings with any Medicaid-approved provider. Many providers follow the Bright Futures schedule, which includes recommendations for screenings and exams at specific ages. To set up an EPSDT screening, contact your child’s primary care provider or reach out to a Medicaid-participating clinic.
- Provider Options for EPSDT Services: Michigan Medicaid works with a network of health care providers who offer EPSDT services, including pediatricians, family medicine doctors, and dental providers. Families can use a Medicaid provider directory to find a nearby provider who accepts Medicaid and offers EPSDT services.
- Specialty Care Referrals: Medicaid providers can refer children to specialists within the Medicaid network if a screening or test shows a need for specialized care. These referrals are often covered under EPSDT, and you can check coverage options with your provider.
How McLaren Health Plan Supports EPSDT
McLaren Health Plan can support you and your family in accessing Medicaid benefits as well as EPSDT services so your children receive comprehensive care. We make it easy for members to use EPSDT benefits and find the right benefits.
Navigating EPSDT Services
Navigating health care services can sometimes be challenging, and that’s why we offer ongoing support. We can help you enroll in Medicaid/MIChild so you and your family get the coverage you need. We will also help you coordinate screenings, diagnostics and treatments for you and your children.
McLarenHealth Plan offers personalized assistance to Medicaid members, helping you understand EPSDT services, find providers, and schedule appointments. The goal is to empower families to take advantage of EPSDT’s full benefits, so your children can access the health care services they need.
Medicaid Support Resources
McLaren Health Plan provides additional resources for Medicaid families. This includes information on Medicaid coverage, guidance on accessing specific services, and tips for maintaining preventive care routines for the whole family. We want you to make informed decisions about your child’s health care needs.
For additional support, contact McLaren Health Plan. We’re here to answer questions, provide information on specific EPSDT services, and offer guidance on accessing health benefits in Michigan.
McLaren Health Plan provides quality health insurance solutions for every stage of life, specifically tailored for Michigan residents. From individual coverage to family plans and Medicare, find out which plan is right for you.
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