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​The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is federally mandated Medicaid program for children. In Kentucky, it is divided into two components: EPSDT Screenings and EPSDT Special Services.

The EPSDT Special Services program covere medically necessary items or services considered treatment and not covered by other Medicaid benefit.

Services

EPSDT Special Services may be preventive, diagnostic/treatment or rehabilitative. Examples of services covered through the EPSDT Special Services include:

  • additional pairs of eyeglasses after the Medicaid Vision Program has paid for the first two pair in a year,
  • additional dental cleanings after the Medicaid Dental Program has paid for one cleaning,
  • nitrous oxide used in dental treatment,
  • nutritional products used as a supplement rather than as the child's total nutrition.

All EPSDT special services require prior authorization.

Some services that the EPSDT Special Services does not cover include:

  • respite care
  • environmental services
  • educational services
  • vocational services
  • cosmetic services
  • convenience services
  • experimental services
  • over-the-counter items

Eligibility

EPSDT Special Services may be provided only to individuals younger than 21.

Services may be provided through the last day of the month in which the individual turns 21. For example, if someone is receiving services through the EPSDT Special Services Program and turns 21 on March March 16, that person may continue to receive services through EPSDT Special Services through March 31 (if still eligible for Medicaid.)

If you questions, please contact Member Services at (800) 635-2570

If your child in enrolled with a Managed Care Organization (MCO), you may it at:

Provider Information 

How do I verify eligibility?

Once eligibility is confirmed, verify continued eligibility by contacting the automated voice response system at (800) 807-1301 or visiting KYHealth-Net System

Provider Contact information

  •  For billing questions, contact DXC at (800) 807-1232 or visit the website
  • For provider questions, contact the Provider Services Call Center at  (855) 824 5615
  • For provider enrollment or revalidation questions, contact Provider Enrollment at  (877) 838-5085
  • For KyHealth-net assistance, email DXC 
  • To report fraud and abuse, contact Fraud Hotline at (502) 564-2348
  • For pharmacy questions, contact Pharmacy Support Center at (800) 432-7005
  • For pharmacy prior authorization questions, contact Pharmacy Prior Authorization at (800) 477-3071

MCO Information