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Early and periodic screening, diagnosis and treatment (EPSDT) is a federally mandated Medicaid program for children. In Kentucky, it is divided into two components: EPSDT screenings and EPSDT special services.

The EPSDT special services component covers medically necessary items or treatment services not covered by other Medicaid benefits.

Services

EPSDT special services may be preventive, diagnostic/treatment or rehabilitative. All EPSDT special services require prior authorization. Examples of services covered through EPSDT special services include:

  • Additional pairs of eyeglasses after the Medicaid vision benefit has paid for the first two pair in a year.
  • Additional dental cleanings after the Medicaid dental benefit has paid for one cleaning.
  • Nitrous oxide used in dental treatment.
  • Nutritional products used as supplements rather than as the child's total nutrition.

Some services not available through EPSDT special services 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 to only 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 receiving EPSDT special services turns 21 on March 16, that person may continue to receive 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 is enrolled with a managed care organization, you may contact it at: