4.26.5 Early Periodic Screening, Diagnosis and Treatment (EPSDT)



Practice Guidance

  • ​A child in OOHC who is eligible for Medicaid is also eligible for EPSDT services, such as: 
    • Immunizations; 
    • Hearing tests; 
    • Vision tests; 
    • Physical health examination; and 
    • ​Other services for early detection of conditions and provisions of routine well child care. 
  • A child in OOHC who is eligible for Medicaid may also be eligible for EPSDT special services, which are not routinely covered by Medicaid, but are medically necessary and pre-authorized by Medicaid. For example, if a provider can demonstrate medical necessity for unique durable medical equipment, EPSDT special services may cover its cost.


The SSW:

  1. Follows procedures outlined in SOP 4.26 Meeting Basic Health Care Needs; 
  2. Documents the use of EPSDT services when appropriate.