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Early Periodic Screening, Diagnosis & Treatment

Periodic health screening, diagnosis, and treatment for children; includes vision, hearing, and dental assessments; may also cover screening for physical, mental, or developmental problems when needed.

Many figures used to calculate EPSDT benefits are revised annually by the Department of Health and Mental Hygiene (DHMH), the state agency that administers the program. These figures are usually updated in October or November and on the DHMH website.

Eligibility

Children under 21 years old and must be eligible for Medical Assistance

Income Eligibility

Must be eligible for Medical Assistance; Income below "medically needy income level" for household size, or "incurred" medical expenses equal the "spend down" amount by which income exceeds the income limit.

Asset Eligibility

Must be eligible for Medical Assistance.

Apply at

Department of Social Services.  Find your local DSS Office

Appeals
  • Appeals must be filed in writing at the DSS office.  It is best to file it in person and to get a receipt showing that you filed the appeal.
  • Appeals must be filed within 90 days of the action, or you cannot appeal.
  • If you file within 10 days of notice that benefits are being terminated or reduced, they will continue until the decision.  If you do not appeal within 10 days, the termination or reduction will happen
Source of Funds

State and federal

Sources of Law

Federal Law: 42 U.S.C. §1396d(r)  (Definition, services required...) This is a long page, and you will have to scroll most of the way down to find this section.
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Federal Regulations: 42 CFR 441.50 to 441.62 Scroll down the page to find these numbered sections.  You can read the documents either as Acrobat PDF files or as plain text.

State Regulations: COMAR 10.09.23.00 to 10.09.23.9999; Scroll down the list of chapters to "Chapter 23 - Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Screening Services." Click the Chapter title to open the list of regulations.

Originally posted by Anonymous on Aug 17, 2010, last updated by Mary Jo Lazun on Aug 13, 2012
Tags: Government Benefits & Services > Medical Benefits, Youth Law > Health Issues, Health

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