Early and Periodic Screening, Diagnostic and Treatment Program

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid. Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States must cover a broad array of preventive and treatment services. Unlike private insurance, EPSDT is designed to address problems early, ameliorate conditions, and intervene as early as possible. For the 25 million children enrolled in Medicaid and entitled to EPSDT in 2012, the program is a vital source of coverage and a means to improve the health and well-being of beneficiaries.

While a small number of cases and anecdotes regarding high EPSDT costs have garnered public attention, spending per child is low compared with worker-age adults and seniors covered by Medicaid. This is true despite the breadth of coverage provided to children through EPSDT. Children account for approximately half of Medicaid beneficiaries but only roughly 20-25 percent of the costs of the program overall. With Medicaid and EPSDT, however, poor children's access to health care is similar to that of non-poor, privately insured children and child Medicaid beneficiaries use care in approximately the same pattern as their privately insured counterparts. On average, Medicaid costs per child are less than private insurance.

EPSDT was enacted in 1967 as part of Medicaid as the child health component of Medicaid, with a deliberate focus on prevention and early intervention to reduce health problems among poor children and offer them equal opportunity to succeed in life. The design of EPSDT encompasses the vision of President Johnson and the Congress in order "to discover, as early as possible, the ills that handicap our children" and to provide "continuing follow up and treatment so that handicaps do not go neglected." While children were eligible for Medicaid from its original enactment in 1965, no specific standards related to child health coverage were included. Within two years, however, policymakers would focus on the range and depth of Medicaid coverage for infants, children, and adolescents. President Johnson’s concern for the well-being of poor children was one political force. In 1967, as he transmitted his program for America’s children and youth, President Johnson said: “Recent studies confirm what we have long suspected. In education, in health, in all of human development, the early years are the critical years. Ignorance, ill health, personality disorder--these are disabilities often contracted in childhood: afflictions which linger to cripple the man and damage the next generation. Our nation must rid itself of this bitter inheritance. Our goal must be clear--to give every child the chance to fulfill his promise.” Another set of arguments in support of EPSDT was in a report on young men found unqualified for military service, which concluded that the majority of those rejected for service in the early 1960s failed as a result of physical and mental health conditions which might have been prevented or treated in childhood.

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