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Medicaid is a joint program of the federal and state governments that provides medically necessary services to low-income families and children who meet specific eligibility requirements.

The numbers of children who have special needs and receive Medicaid has risen significantly in recent years. For many eligible children, Medicaid is often their sole source of health insurance. In some cases, individual participants may be asked to share in the cost for certain services.

Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program

Unlike Medicaid HCBS waiver services, Medicaid state plan services are typically restricted to covered services, and for children include services covered under the federal Early Periodic Screening, Diagnosis and Treatment (EPSDT) program, which mandates basic preventive and therapeutic health services that are deemed appropriate and necessary for children. Some states may elect to qualify school-based personnel as service providers. Each state sets its own guidelines and determines who is eligible and which optional services are covered.

For More Information

To understand what your state offers, visit your state’s Medicaid Web site, the Centers for Medicare & Medicaid Services (CMS) Web site at www.cms.gov, or the CMS Medicaidspecific Web site at www.medicaid.gov. You can also get information from other parents and disability organizations.

 

Last Updated
10/3/2013
Source
Autism Spectrum Disorders: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2012)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.