The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program is a child health initiative for Medical Assistance members. Think of it like this:
Your child’s good health starts with having regular checkups with their primary care provider (PCP). Your child's PCP will complete a yearly physical exam to make sure they are growing well, as well as conduct preventive screenings based on your child’s age, sex and medical history to make sure they do not have any health problems. For more information on our program and checkups, screenings, and test schedules, download our program brochure. (PDF)
At a minimum, diagnosis and treatment for defects in vision, including eyeglasses. Vision services must be provided according to a distinct periodicity schedule developed by the state and at other intervals as medically necessary. For additional information visit the Vision and Hearing Screening Services for Children & Adolescents page.
At a minimum, dental services include relief of pain and infections, restoration of teeth, and maintenance of dental health. Dental services may not be limited to emergency services. Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health.
At a minimum, hearing services include diagnosis and treatment for defects in hearing, including hearing aids. For additional information visit the Vision and Hearing Screening Services for Children & Adolescents page.
States are required to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.
When a screening examination indicates the need for further evaluation of an individual's health, diagnostic services must be provided. Necessary referrals should be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation. States should develop quality assurance procedures to assure that comprehensive care is provided.
Necessary health care services must be made available for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.
The Delaware Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program now requires that all children with Medical Assistance receive a minimum of two (2) blood lead screenings regardless of the child’s risk factors. The tests should be conducted at the 12 month screening and again at the 24 month screening.
The good news is these screening tests will not cost our members anything! You can schedule an appointment with your child’s pediatrician to have his or her blood levels checked. If you don’t have a pediatrician, you can find one close to you through our Find a Provider tool.
Lead is a toxic metal used in a variety of products and materials found in your home, including: Paint and/or dust in older homes, soil that contains traces of lead, water that runs through lead pipes, some toys and jewelry, some makeup products, and certain jobs and hobbies can involve working with lead-based products and may cause parents to bring lead into the home.
Exposure to lead can seriously harm a child’s health. Exposure to lead can cause:
These health problems can impact children long term. These health problems can cause:
Children under the age of 6 are most at risk because they are growing so rapidly. Younger children tend to put their hands and other objects in their mouth which can be contaminated with lead dust. Lead dust can be invisible to the naked eye.
The good news: Lead poisoning is 100% preventable!
Most children with elevated lead levels have no symptoms.
That is why testing is so important! Talk with your child’s doctor about a simple blood lead test. Testing is the only way to know if your child has elevated blood lead levels. This test may be completed by a simple finger stick blood test. If the finger stick shows that your child has high lead in their blood, then your child will be referred for a blood draw.
Your child should be tested:
This test can be completed as part of their regular well child visits to your child’s provider at these ages. Testing is the only way to know if your child has been exposed to lead.
You can still get a lead test done.
Two lead tests should be completed by the age of 2. However, children can be tested even after the age of 2. Children under the age of 6 are at risk.
If a child is not tested at their 2 year visit, the child should be tested as soon as possible after their 2 year visit, but before they turn 6 or enter into Kindergarten, whichever is first.
A lead test can be conducted in 2 different ways.
Capillary blood sample testing – A small lancet (needle) is used to puncture the skin. This can be done on the foot or the finger. A small amount of blood will be collected in a tube.
Venous blood sample testing – A needle is used to collect blood into an attached tube from a vein in the arm. This is the most accurate way to measure lead levels in the blood.
Resource Coordinators from Highmark Health Options Health will reach out to you to assist with coordinating follow up care after a positive lead test.
Depending on your child’s lead level, your physician may recommend an Environmental Lead Investigation. An Environmental Lead Investigation includes an investigation of your home including all painted surfaces, water samples, dust samples, and bare soil samples.
We always encourage honest conversations with your child’s doctor regarding your concerns.
If you have questions regarding coordinating your child’s care, scheduling appointments, help with transportation problems, or questions about your child’s lead test or other wellness visits, please contact the Highmark Health Options Care Coordination Team in the Special Needs Unit for assistance at 1-844-325-6251 (TTD/TTY# 711 or 1-800-232-5460 for hearing impaired).
If you are eligible for Medical Assistance and would like help choosing a plan, contact Delaware Health Benefits Service 1-800-996-9969.