Early and Periodic Screening, Diagnostic, and Treatment Program (EPSDT)

Jan 17, 2023

The goal of the Early and Periodic Screening, Diagnostic, and Treatment Program (EPSDT) is to ensure that individual children get the right care to the right child at the right time in the right setting.  

There are two ways the EPSDT program can be utilized:  

Providing Routine Primary Care and Preventative Services 

EPSDT provides comprehensive and preventive health care services for children under age 21 who are enrolled in MaineCare. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services. 

• Early: Assessing and identifying problems early 

• Periodic: Checking children's health at periodic, age-appropriate intervals 

• Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems 

• Diagnostic: Performing diagnostic tests to follow up when a risk is identified 

• Treatment: Control, correct or reduce health problems found. 

All Other Services 

EPSDT treatment services are services that will be covered for MaineCare members under the age of 21 if certain criteria are met. These services, equipment, or treatment are covered by MaineCare if they are medically necessary but not described in existing regulation, or if they last longer, or are more frequent than the regulations allow.  

In accordance with MaineCare Benefits Manual, Chapter II, Section 94: 

Treatment Services must: 

A. be documented scientifically with valid clinical evidence of effectiveness. (The Department may request additional information to support the assertion that there is scientifically valid evidence of the efficacy of the proposed treatment or service. The Department will request this information if it determines that the service requested is outside the scope of standard medical practice.) 

B. not be considered investigational or experimental 

C. be the most cost-effective service that would provide the member with the same medically necessary outcome and intended purpose 

D. be prior authorized by the Authorization Unit of MaineCare Services. Requests for prior authorization of Durable Medical Equipment will be reviewed by an authorized agent of the Department. 

E. be medically necessary as defined in Chapter I, Section 1.02 (D) 

F. not be custodial, academic, educational, vocational, recreational or social in nature as described in Chapter I, Section 1.02 (D), “General Administrative Policies and Procedures”, of this Manual 

G. not be respite care, which is defined as services given to individuals unable to care for themselves that are provided on a short-term basis because of the absence or need for relief of those persons normally providing the care. 

For more information on MaineCare’s EPSDT Program, please contact Tia Bolduc, EPSDT Coordinator, at DHHS.EPSDT@Maine.gov.