Aging Out of EPSDT – Part III: Losing Coverage

In Part I in this series, we discussed the state of Medicaid and the EPSDT — the Early and Periodic Screening, Diagnosis, and Treatment benefit — which covers most American children with disabilities from birth until 19 (21 in some states) years of age. Since 1989, the EPSDT has required that each state of the Union provide every child with “all medically necessary services” that were available under the Federal government’s Medicaid program, even if that state didn’t offer that service to adults. This coverage is expansive enough that it dwarfs most private insurance.

What is ‘Medically Necessary’?

One major difference is that most states adopt a definition of “medically necessary” that only includes those services that “improve or eliminate a condition,” at least for adults. But the EPSDT’s definition of includes services that “correct or ameliorate defects and physical and mental illnesses and conditions.” That might not sound like … Read More