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NCDHHS »   Providers »   Provider Info »   Mental Health, Development Disabilities and Substance Abuse Services »   Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children

Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children

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.

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

EPSDT Links

  • Listing of EPSDT Service Found in U.S. Social Security Act (42 U.S.C. § 1396d(a) - 1905(a) of the U.S. Social Security Act]
  • Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years of Age

Covered Treatment Services 

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

The services must:

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

Requests for Non-Covered Services

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 DHB.

Files

EPSDT PHP Training- April 04, 2019.pdf

PDF • 6.26 MB - April 18, 2022

SocialSecurityAct.pdf

PDF • 23.38 KB - July 27, 2018

Mental Health, Development Disabilities and Substance Abuse Services

  • Alcohol Drug Education Training School
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  • Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children
  • First Level Commitment Evaluation Program
  • I/DD Systems of Services
  • Look-Behind Quality Assurance Program
  • NC Incident Response Improvement System (IRIS)
  • NC-SNAP (NC Support Needs Assessment Profile)
  • NCTracks
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  • Plan(s) of Correction
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  • Treatment Accountability for Safer Communities (TASC)

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Contact Information

NC Department of Health and Human Services
2001 Mail Service Center
Raleigh, NC 27699-2000
Customer Service Center: 1-800-662-7030
For COVID-19 questions call 1-888-675-4567
Visit RelayNC for information about TTY services.

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https://www.ncdhhs.gov/providers/provider-info/mental-health-development-disabilities-and-substance-abuse-services/early-periodic-screening-diagnostic-and-treatment-medicaid-services-children