Kentucky Partnership for Families and Children

What is EPSDT?
Medicaid’s Early and Periodic Screening, Diagnosis and Treatment for youth under the age of 21.

In Kentucky EPSDT has covered Intensive Outpatient (IOP) treatment, residential treatment, and inpatient treatment programs for adolescent substance abuse. It is not often used to cover outpatient treatment or case management services, two services adolescents may benefit from.

Only parties who are eligible to bill Medicaid can be approved to provide EPSDT funded services. Potential providers include the community mental health centers (CMHC) and other “health care providers”, public and private (ex. Ten Broeck, The Ridge, Rivendell, Caritas, etc),

EPSDT is an entitlement (or a right to benefits) for Medicaid eligible youth who need screening, diagnosis, and treatment for “medically necessary” problems.

Medicaid defines what is “medically necessary” for the state’s EPSDT program.

Problems for Providers
Providers have to have a Medicaid provider number and a separate EPSDT number. While mental health treatment services are defined in a Medicaid manual and available for any Medicaid eligible youth with a medically necessary treatment need. The same is not true for substance abuse treatment. Programs that provide youth with medically necessary substance abuse treatment services must first get their program approved. Then they must receive an approval (pre-authorization) number for each youth requiring the service. This pre-authorization process can be time consuming.

How Families can Access EPSDT
Ask your service coordinator or case manager to explain EPSDT and how to access it for your youth’s substance abuse screening, diagnosis and treatment.

Ask your treatment provider if they have an EPSDT provider number. This will be different from their Medicaid provider number.

Ask your treatment provider if they have a Medicaid approved program to provide adolescent substance abuse treatment.

If you’re told that treatment is not available, or that the funding for treatment is not available, then it’s time to act and demand equality in treatment availability. Contact KPFC to learn how you can help!

Resources
KY Partnership for Families and Children, Inc.
(800) 369-0533
www.kypartnership.net
kpfc@kypartnership.net

KY Department for Medicaid Services
(800) 635-2570
http://chfs.ky.gov/dms/

The Centers for Medicare and Medicaid Services-EPSDT services overview
http://www.cms.hhs.gov/MedicaidEarlyPeriodicScrn/

U.S. Department for Health and Human Services-Health Resources Services Administration EPSDT overview
http://www.hrsa.gov/epsdt/default.htm
comments@hrsa.gov

The Bazelon Center for Mental Health Law
www.bazelon.org

*for a one-page, formatted copy of this document, please contact the KPFC office