EPSDT
EPSDT
Are you a Health First Colorado member struggling to navigate the complex world of healthcare for your children or during pregnancy? You’re not alone. Many people feel confused about what services are available, what Medicaid covers, or how to get the care they need. But don’t worry, help is available! The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program is here to make sure you and your family get the care you need to stay healthy.
Everything You Need to Know About EPSDT
What is EPSDT?
The EPSDT benefit covers medically necessary services for children, youth, and pregnant adults on Medicaid. This includes screenings, diagnostic tests, and treatments. Covered services may include preventive care, dental care, mental health support, developmental services, and visits to specialists.
Early: Assessing and identifying problems early
Periodic: Checking children’s health at periodic, age-appropriate intervals
Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
Treatment: Control, correct, or ameliorate health problems found.
The EPSDT benefit is for Health First Colorado members age 20 and under and pregnant individuals.
Learn more about EPSDT at https://hcpf.colorado.gov/epsdt.
What does EPSDT cover?
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers a wide range of health care services for children, youth (ages 20 and under), and pregnant adults enrolled in Health First Colorado (Medicaid). These services are meant to keep members healthy, find problems early, and provide treatment when needed.
Screening Services
Regular check-ups that include:
- A full health and development history
- A complete physical exam
- Immunizations (shots) recommended for age
- Lab tests (including lead toxicity testing)
- Health education about growth, safety, and healthy habits, disease prevention
Vision Services
Covers eye exams and treatment for vision problems, including glasses.
Dental Services
Includes exams, cleanings, fluoride treatments, pain relief, and fixing or restoring teeth.
For more information on dental services, read the American Academy of Pediatric Dentistry Periodicity of Examination and Preventive Dental Services.
Hearing Services
Covers hearing exams and treatment, including hearing aids if needed.
Diagnostic Services
If something is found during a check-up, additional tests and evaluations are covered to better understand the issue.
Treatment
Covers care for any physical or mental health issues found during screenings or exams. This may include visits to specialists, therapy, medications, or other needed services.
Other Medically Necessary Services
Additional services are covered if they are needed to treat or improve a health condition. Health First Colorado decides if something is medically necessary based on each member’s needs.
Lead Screenings
Lead testing is required for children at 12 and 24 months. If a child hasn’t been tested by age 3, they should be tested between 3 and 6 years old.
Refer for transportation assistance.
How and where can I get EPSDT services?
If you qualify for services under the EPSDT you can get services or care from any provider who accepts Health First Colorado. Contact a NHP care coordinator to learn more or get connected to a provider: 888-502-4190.
Well Child Visits
Routine well-child visits are one of the most important ways to support your child’s health and development. These visits are fully covered through your child’s Health First Colorado benefits, so there’s no cost to you.
During a well-child visit, your child’s provider will carefully assess their growth, development, and behavior. They will also perform any necessary screenings or lab tests based on your child’s age. Immunizations recommended for your child’s stage of life will be given as well. If your child needs to see a specialist, your provider will help arrange that.
There’s also time set aside during the visit for you to ask questions or share any concerns you might have. Your provider will give helpful advice and tips on how to keep your child healthy and safe. These visits play a key role in making sure your child stays on track and grows up strong.
Recommended Well-Child Visit Schedule
Health First Colorado covers well-child visits for children from birth through age 20. The recommended schedule of Health First Colorado is the American Academy of Pediatrics’ Bright Futures Guidelines Periodicity Schedule.
All these visits come at no cost to you, making it easy to keep up with your child’s health care needs.
Call your primary care provider’s (PCP) office today to schedule an appointment.
NHP is available to assist if you need help:
- Finding a primary care provider for your child
- Scheduling appointments
- Arrange for transportation to and from appointments
- Connect with a Care Coordinator
Transportation
For transportation assistance to and from appointments, visit our Transportation page.
Additional EPSDT Resources:
Health First Colorado Handbook
EPSDT Tip Sheet – English
EPSDT Tip Sheet – Esp
Bright Futures – Preventive Screenings and Health Supervision
Recommendations for Preventive Pediatric Health Care Periodicity Schedule
Health First Colorado EPSDT Information
Pregnant
Expecting a baby? Health First Colorado offers full care during pregnancy to help ensure a healthy pregnancy, safe delivery, and the best start for you and your baby.
Children & Youth
School-Based Health Centers (SBHCs)
School-Based Health Centers (SBHCs) make it easy for students to get the care they need, right at school. Funded by the Colorado Department of Public Health and Environment (CDPHE), these centers serve children and teens who attend the school or live in the district.
Services may include:
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Regular checkups and well-child exams
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Sick visits when students aren’t feeling well
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Health screenings and immunizations
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Mental health and counseling support
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Substance use screening and guidance
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Dental (oral health) screenings
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Reproductive health care
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Health education and wellness activities in classrooms or school-wide
SBHCs are designed with families in mind. Many offer same-day appointments or accept walk-ins, so students can get care without missing much class time, and parents don’t have to take time off work.
Located in schools across Colorado, SBHCs provide convenient, high-quality medical and behavioral health care for children, youth, and young adults.
Find A SBHC Near You
Where can I find an SBHC located in Colorado?
Refer to the Youth Healthcare Alliance map of school-based clinics to find SBHCs across Colorado. Note that not all of the SBHCs participate in the CDPHE SBHC Program.
Where can I find a school-linked health care site located in Colorado?
Refer to the School-linked Sites filter on the Youth Healthcare Alliance School-Based Clinic Location map to find Colorado school-linked health care sites.
Vaccines for Children
The Vaccines for Children (VFC) program helps make sure that all kids can get the vaccines they need to stay healthy, at no cost to families.
Vaccines for Children (VFC) Program
VFC
The Vaccines for Children (VFC) Program provides free or low-cost vaccines to help keep kids healthy and protected from serious diseases. This federally funded program, managed by the Centers for Disease Control and Prevention (CDC) and the Colorado Department of Public Health and Environment (CDPHE), ensures that all children, no matter their family’s ability to pay, can get the vaccines they need.
Children and teens 18 years old and younger are eligible if they are:
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Uninsured (no health insurance)
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Underinsured (insurance doesn’t cover recommended vaccines)
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Enrolled in Medicaid or Medicaid-eligible
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American Indian or Alaska Native
Many of these vaccines are required for school aged children to attend licensed child cares and K-12 schools in Colorado.
Find a Vaccine Provider in Colorado
Across Colorado, more than 600 clinics, community health centers, and local public health agencies participate in the Vaccines for Children (VFC) Program. These providers offer free or low-cost vaccines for eligible children and teens up to 18 years old.
You can use the interactive map or provider list below to find a participating VFC clinic near you.
Some locations may also provide free or low-cost vaccines for uninsured or underinsured adults (ages 19 and older). These sites are noted on the map for your convenience.
Please note that vaccine availability can vary by location, and not every site offers vaccines for both children and adults. It’s a good idea to call ahead to confirm which vaccines are available and whether any fees apply.
If you or your child are eligible for publicly funded vaccines, you have the right to receive them at no cost.
Learn more about your rights and how to access these services below.