Medicaid for Children (EPSDT)
All children who qualify for Medicaid are entitled to early and periodic screening, diagnosis, and treatment (EPSDT). EPSDT benefits include all treatment and services in the federal Medicaid Act that are medically necessary to improve or maintain a child’s overall health, whether or not the services are covered for adults under the North Carolina Medicaid Plan. If a family is denied approval for a service, or Medicaid reduces or changes the level of recommended service, a family has a right to appeal this decision. If the appeal is regarding a change in the level of service, the child continues to receive his or her previous level of services until all appeals have been concluded. If a child has been denied a Medicaid service that the child’s medical providers believe is medically necessary, then the provider should refer the family for legal analysis and potential representation.
The Division of Medical Assistance (DMA) has information for providers on the EPSDT program, including two powerpoint training presentations. Visit the DMA website for Health Check and EPSDT for Providers about Medicaid Services for Children (and click on training slides on right).