To ensure the health and security of children receiving Medicaid, it helps to know about the Early and Periodic Screening, Diagnosis, and Treatment (or EPSDT) benefit. In this article, you’ll learn more about the benefit, its eligibility requirements, and what it does.
What is the EPSDT in Louisiana?
The EPSDT is a federally mandated Medicaid benefit each state must make available to youths under 21. In Louisiana, the program ensures children catch medical problems early so they can receive appropriate treatment.
The EPSDT is an aspect of Medicaid in all states, and you’ll find different names and features in those states. In Louisiana, the unique feature its residents get is personal care, which you can learn more about in the “what does the EPSDT do” section.
Who Qualifies for the EPSDT in Louisiana?
In Louisiana, children who qualify for the EPSDT must meet two conditions:
- They’ve already exhausted (or are not receiving) Individual Family Support waivers
- Between the ages of 0 and 20
These conditions ensure that children in need of care receive it, regardless of the financial situation of the family. In this way, it’s similar to the Children’s Choice waiver. However, the EPSDT differs in focusing more on general medical and developmental needs, not just needs for people with disabilities.
Do You Need to Apply for the EPSDT?
Because the EPSDT is a benefit, families do not need to apply to have their children covered. Instead, it’s an automatic part of Medicaid coverage, kicking in when waivers run out (or if waivers don’t apply).
What Does the EPSDT Do?
The EPSDT ensures that children (teens, infants, adolescents) receive the proper medical, dental, hearing, vision, mental, and care they need to thrive. In Louisiana, this includes personal care to help those with disabilities thrive despite their physical or mental limitations.
Here’s more detail on how the EPSDT works across many needs:
- Personal care – This is a unique aspect of Louisiana’s EPSDT. It includes services for toileting, grooming, bathroom problems, eating, food preparation, household chores, and transportation to medical appointments. It does not include medication, tube feeding, catheters, or tracheostomy care.
- Vision, dental, and hearing – Managing defects in vision, addressing tooth pain or maintenance, and handling defects in hearing are all included. The EPSDT also covers regular checkups in these areas.
- Diagnostic and treatment – All states must evaluate health, produce said evaluation, and provide healthcare services for all physical and mental conditions discovered during the initial screening process.
- Developmental and behavioral screenings – A required screening for enrolled children to ensure they reach proper developmental milestones (physically and mentally).
- Lead screenings – An evaluation to determine if a child has been exposed to lead or suffers from lead poisoning.
How Do Case Management Agencies Help You With Your EPSDT Coverage?
Case management agencies assist in connecting you with comprehensive healthcare services for those under 21. Working with case managers can help you understand some nuances of this coverage, such as when individual waivers end and your EPSDT coverage begin.
