EPSDT Aging – Part I: What is EPSDT?

Medicaid is a joint program funded by the US federal government and several states; provides health coverage for low-income Americans. Both critical health services and long-term care are available to an estimated 52 million Americans (about 1 in 7 US citizens) through this powerful program, including more than a million disabled youth ages 21 and younger. . More than 20% of the disabled youth population receives Medicaid, including 7 out of 10 low-income children with disabilities.

These disabilities span a wide range, including physical conditions like cerebral palsy or congenital blindness, and mental conditions like dyslexia or autism spectrum disorders. The main coverage channel for disabled children, Supplemental Security Income (SSI ‘disability’ payments), is intended primarily for children with a primary mental disability, such as a developmental disability or an emotional disturbance.

Because Medicaid is hammered out between the federal and state governments, both have a say in how it works. The federal government sets basic eligibility requirements and broad benefit guidelines, but each state defines precisely what income ranges qualify in their territory and what services they will offer. However, in an effort to support children’s health, the federal government is much stricter about child benefits, forcing states to accept children with a much higher income threshold than what most choose to accept adults, and offer them a much broader and higher quality outreach. set of services offered by adults.

The first and most important federally mandated service for children with disabilities is called the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. This benefit begins at birth and is responsible for paying for all hearing, vision, dental, mental/emotional, and physical exams your child receives at no cost from their school and medical provider, as well as for immunizations. If a child is found to have a genuine medical problem and is low-income, the “treatment” portion of the program kicks in to pay for whatever form of standardized treatment the state provides.

… And we present ‘Aging Out’

All of which is absolutely amazing… until the child turns 19 (21 in some states). By the time a person with a disability is no longer a ‘youth’, they suddenly find themselves with absolutely nothing in terms of Medicaid benefits unless they qualify for one of the disability programs. Even those who qualify for an adult-oriented Medicaid disability program often find that their new program (no longer subject to federal child-friendly rules) is sorely lacking in support compared to their old one.

This sudden decline in support and benefits is known as “aging,” and it is the most difficult issue many American parents of children with disabilities will face as their children transition into adulthood. In upcoming posts, we’ll explore the effects of moving from EPSDT to “regular” Medicaid, and offer some of our best advice on coping with the transition if you’re a parent of a disabled child. .