EPSDT PROGRAM

Medicaid covers a broad array of health and dental services for recipients under age 21. Early Periodic Screening, Diagnostic and Treatment (EPSDT) is known in North Carolina as Health Check and is defined by federal law. EPSDT/Health Check are important because it:

1. Provides early and regular medical and dental screenings for all Medicaid recipients under age 21.
2. Is a part of the federal Medicaid EPSDT requirement that provides recipients with medically necessary health care to correct or ameliorate a defect, physical or mental illness or a condition identified through a screening examination.

EPSDT/Health Check includes periodic screening, vision, dental and hearing services. In addition, section 1905(a) of the Social Security Act requires that any medically necessary health care service listed in section 1905(a) be provided to a Medicaid recipient under age 21 even if the service is not available under the State’s Medicaid plan. EPSDT may also cover some services that are not covered for recipients aged 21 and older. Health Check examinations and other Medicaid covered services are free of charge to the recipient.

All requests for services must be made in conjunction with the recipient’s physician or other licensed clinician and in accordance with the Division of Medical Assistance’s published procedures. If approval of a request is denied or services are reduced or terminated, the recipient or his/her representative will receive written notification. Additionally, the notice will contain information about how the decision may be appealed.

For additional information about Health Check and EPSDT, visit the address below:
http://www.dhhs.state.nc.us/dma/EPSDTconsumer.htm