Access and Coverage
Medicaid and the Children's Health Insurance Program

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Medicaid and CHIP are required to provide eligible child enrollees with an Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit, which is designed to screen, diagnose, and treat children at early and appropriate intervals of care. The EPSDT benefit includes medical, dental, hearing, and vision services, and each state establishes its own periodicity schedule (typically by age) based on Bright Futures guidance from the American Academy of Pediatrics and the Health Resources and Services Administration.

Using state-reported information (states are not required to report vision or hearing screenings), the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS), in 2010, determined that 76% of children across 9 states did not receive all required EPSDT screenings with more than half not receiving any required vision or hearing screenings. In a follow-up report in 2014, the HHS OIG recommended that CMS require states to report vision and hearing screenings and increase collaboration with states to encourage both beneficiary and provider incentive to participate in and conduct EPSDT screenings. Looking ahead, Prevent Blindness will advocate for policy changes such as provider reimbursement, accountability measures, and requiring that results of vision screening and completion of referral to eye care are reported, as recommended by the HHS OIG report.