Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Children ages 0-20 have access to health care services with a primary care provider (PCP). This program is called “Early and Periodic Screening, Diagnosis and Treatment” (EPSDT). This benefit covers:

Age-based screening visits
Services to treat physical, dental, developmental, and mental health conditions. (For OHP covered services)
Immunizations
Care Coordination
Healthcare treatment and other measures to correct or help with any defects and chronic conditions

Services are at no cost to the member. Your PCP may be a physician (MD/DO), Nurse Practitioner (NP), or Physician’s Assistant (PA). The PCP will be your main source for accessing these care visits. If you have questions about your PCP, please call Member Services.

Screening Visits

Screening visits occur on a schedule. These visits include:

A complete, unclothed, physical exam, including checking teeth and gums
A health history (including both physical and mental health)
Developmental screenings
Screening laboratory tests (including lead toxicity testing)
Immunizations
Dental Care
Vision and hearing screenings
Guidance and health counseling for parents and children

To access these visits, please call your PCP’s office. They will help schedule you for a visit.

Recommended vaccinations and well child visits are covered benefits. You can see the recommendations below:

Non-Emergent Medical Transportation (NEMT) is offered to members and their families to get to these visits. Please call Bay Cities Brokerage for more information.

Referral Diagnosis and Treatment

Screenings may help a provider find a condition. You have access to get these conditions diagnosed and/or treated. You can be referred to the right provider for care.

Referrals include:

Explaining why a referral is needed
Member, parent, or guardian must agree to the referral
Help to get referred to the right provider for your needs
Care coordination and Case management. It could be from Advanced Health or your PCP office

The following services will be provided if your screening shows you need it:

Hearing and vision care
Dental care
Immunizations
Referrals to social services, nutrition, and education programs

Screening and treatments should be done in a timely manner, within six months of the request.

Some programs are not covered by EPSDT:

Supplemental Nutrition Assistance Program (SNAP)
Other social services programs

For more information, please call Member Services at 541-269-7400. We can help refer you to these programs.