Skip all navigation Skip to page navigation

DHHS Home | A-Z Site Map | Get Updates | Divisions | About Us | Contacts | En Español

NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

EPSDT

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the federal law that says Medicaid must provide all medically necessary health care services to Medicaid-eligible children. Even if a service is not covered under the NC Medicaid State Plan, it can be covered for recipients under 21 years of age if the service is listed at 1905(a) of the Social Security Act and if all EPSDT criteria are met.

Together, Health Check and EPSDT provide for the complete care of children and youth in Medicaid.

EPSDT Quick Links

What Treatment Services are Covered?

Services must be ordered by the child's physician or another licensed clinician. Prior approval from the Division of Medical Assistance may be required to verify medical necessity for some services.

The services must meet all of the conditions stated below:

  1. The service must be medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that is identified through a screening examination
  2. The service must be listed in section 1905(a) of the Social Security Act.
  3. The service cannot be experimental/investigational, unsafe or considered ineffective.

Requests for Non-Covered Services

Beginning on April 1, 2014, NCTracks will process all prior approval requests for services coverable under the scope of Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for beneficiaries under 21 years of age. Before to this date, prior approval requests for many EPSDT coverable services were being processed by the N.C. Division of Medical Assistance.

A full explanation of the EPSDT policy and how to obtain approval for services can be found in: