EPSDT and Priority Partners

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is a federal requirement that mandates States to cover certain benefits for Medicaid recipients from birth up to age 21. In Maryland, the preventive care component of the EPSDT Program is known as the Healthy Kids Program. The preventive health care services allow for early identification and treatment of health problems before they become medically complex and costly to treat. Please note that Medicaid’s mandates through the EPSDT Program are different than non-Medicaid health plan requirements for childhood care.

Priority Partners would like to remind providers that parents rely on you to direct their child’s care and ensure they receive all of the services they need. By understanding the EPSDT schedule and preventive requirements, you can help our members grow and develop into healthy adults.

We would especially like to remind you about lead testing and well-care visits. Every child in Maryland (not just those in high-risk areas or older homes) must be tested for lead poisoning in the year that they turn one. Also, as children age into adolescence, the attendance of well-care visits decreases. It is important to encourage your patients to continue their yearly well-care visits.

EPSDT Components

Maryland Health Kids Preventative Health Schedule

EPSDT laboratory screening tests

  • Type: metabolic screenings (PKU) phenylketonuria
    When: 2 screenings, first test completed at birth
  • Type: Lead and anemia screenings
    When: ages 12 and 24 months
  • Type: Dyslipidemia screenings
    When: ages 9-11 and 18-20
  • Type: HIV testing
  • When: 1 test, between ages 15 and 18

EPSDT risk assessments and screenings

  • Type: Tuberculosis
    When: ages 1 month, 6 months and annually
  • Type: Lead
    When: age 6 months and at every well visit until age 6
  • Type: Autism
    When: 18-month and 24-30-month visits
  • Type: Heart disease
    When: age 2 and annually
  • Type: Anemia
    When: age 11 and annually
  • Type: STI/HIV
    When: age 11 and annually
  • Type: Maternal depression
    When: child is age 1 month, 2 months, 4 months and 6 months
  • Type: Substance abuse
    When: age 11 (or younger, if indicated) and annually
  • Type: Depression
    When: age 11 and annually

We thank you for the tremendous work you do in ensuring your adolescent patients receive this important preventive care. Here are a few additional reminders:

  • Update the child’s medical record with immunizations, screenings and assessments.
  • Ensure the child’s vaccine history is updated and completed.
  • Provide a documented referral to a dentist starting at age 2 and then annually.
  • Enroll in the Vaccines for Children (VFC) program and the Maryland immunization registry (ImmuNet) to update the child’s immunization history.

We are in this together. If we can support you in caring for your adolescent patients, please call us at 888-895-4998.

More EPSDT Information: