Helping children stay healthy is important to their well-being and development. The Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit through Health First Colorado (Colorado’s Medicaid program) provides essential care and services to children and teens that support their whole-person health.
What Is EPSDT?
EPSDT is a benefit for children and teens ages 20 years and younger who have Health First Colorado. It helps children stay healthy by detecting and treating problems early. EPSDT also provides administrative case management for pregnant adults with Health First Colorado coverage. All eligible members who are part of our regional accountable entity (RAE, or sometimes called a regional organization) or RMHP PRIME have this benefit.
EPSDT stands for:
- Early: Finding health problems as soon as possible.
- Periodic: Getting regular checkups and screenings.
- Screening: Checking for health problems like vision, hearing, and dental issues.
- Diagnostic: Doing tests if a doctor thinks something might be wrong.
- Treatment: Getting care to fix or manage health problems.
Services Covered by EPSDT
The EPSDT benefit provides comprehensive and preventive care. It covers any medically necessary service to treat any physical, dental, vision, or mental diagnosis — even if it’s not a Health First Colorado benefit or if there are service limits.
EPSDT services that are covered for no cost or copay include:
- Well-child visits and teen checkups
- Developmental evaluations
- Behavioral evaluations and therapies
- Vaccinations
- Lab tests, including lead poisoning testing
- Health and preventive education
- Vision services
- Dental services
- Hearing services
- Depression screening for youth and for a parent by the child’s provider
- Other medically necessary health care services, diagnostic services, and treatment
More details about these services, as well as information about medical necessity, can be found in the Health First Colorado Member Handbook.
How to Use EPSDT Benefits
As the Region 1 RAE, Rocky Mountain Health Plans can help eligible children and pregnant adults get the services they need. We can:
- Help you understand the services available to you
- Find providers
- Make appointments for you
- Coordinate between providers
- Connect you to other community services or programs, including food assistance, housing agencies, child care, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and more.
Learn More About EPSDT
Understanding what the EPSDT benefit includes and how it works is important in helping your child get the care and services they need. We’re here to help. Call us at 800-421-6204 (TTY: 711), 8 a.m. – 5 p.m. MST, Monday – Friday.
