Health Check and EPSDT

Medicaid-eligible children have certain federal rights to services, even if they are not normally covered by Medicaid.

  • Health Check helps children under the age of 21 receive regular preventive medical care, and the diagnosis and treatment of a health program found during screening.
  • Early and Periodic Screening, Diagnostic and Treatment (EPSDT) ensures that children under the age of 21 must be provided all medically necessary health care services.

Health Check and EPSDT Services

The child’s physician or another licensed clinician must order services. Prior approval from Medical Assistance may be required. The services must meet all of these conditions:

  • Medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that is identified through a screening examination
  • Listed in section 1905(a) of the Social Security Act
  • Cannot be experimental/investigational, unsafe or considered ineffective

CMS 416 Participation Reports, Early Periodic Screening

More Information

Health Check Program Guide

Health Check Coordinator Directory

Oral Health Periodicity Schedule

2016 NCIP/VFC Vaccine Codes


Medical Assistance Operations Section
Phone: 919-855-4050
Fax: 919-715-8548