EPSDT
The EPSDT (Early and Periodic Screening, Diagnostic and Treatment) benefit offers free, comprehensive health care for children and youth age 20 and under, as well as for pregnant adults enrolled in Health First Colorado (Medicaid). These services are provided at no cost to the member when covered under the EPSDT benefit.
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.
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.
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
Transportation
For transportation assistance to and from appointments, visit our Transportation page.
Additional EPSDT Resources:
Health First Colorado Handbook
Bright Futures – Preventative 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.