Early and Periodic Screening, Diagnostic, and Treatment Services
In accordance with the requirements in Section 1905(r) of the Social Security Act and Title 42 Code of Federal Regulations (CFR) Section 441.50
et seq., the Department of Health Care Services (DHCS) is responsible for providing full-scope Medi-Cal beneficiaries under the age of 21 with a comprehensive, high-quality array of preventive (such as screening), diagnostic, and treatment services under Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT). These services are covered without cost.
Medi-Cal Coverage for EPSDT:
Consistent with federal law and regulations for EPSDT, Medi-Cal covers all medically necessary services, including those to "correct or ameliorate" defects and physical and mental illness conditions.
Information for Medi-Cal Beneficiaries:
Infants, children, and youth up to age 21 with full-scope Medi-Cal are able to receive EPSDT services.
More information is available on the
Information for Medi-Cal Beneficiaries resource document.
Information for Medi-Cal Providers
Medi-Cal, health and mental health plans, and enrolled providers should inform Medi-Cal beneficiaries under age 21 about and how to access EPSDT benefits and services through written and oral information.
Helpful Resources and Documents:
Medi-Cal Subscription Service (MCSS): A free service that provides the latest Medi-Cal news. Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website. To subscribe, please click on this website link.
Medi-Cal Provider Manual,
EPSDT - Provides policy information regarding the Early and Periodic Screening, Diagnostic, and Treatment benefit, coverage, and medical necessity.
- Health and Mental Health Plan Letters - These letters are issued to Medi-Cal managed care plans that serve Medi-Cal beneficiaries, and include requirements for providing services under EPSDT.
- All-Plan Letter (APL) 19-010 - This APL clarifies the responsibilities of Medi-Cal managed care health plans to provide EPSDT services to eligible members under the age of 21.
- All-Plan Letter (APL) 19-014 - This APL provides guidance to Medi-Cal managed care plans about the provision of medically necessary Behavioral Health Treatment (BHT) services for members under the EPSDT benefit and in accordance with mental health parity requirements.
- 21-019 provides clarification on medical necessity determination and level of care placement as part of California's Advancing and Innovating Medi-Cal (CalAIM).
- 18-048 provides guidance on data submission requirements for EPSDT services.
- 17-052 describes specialty mental health services performance outcomes system functional assessment tools for children and youth.
- 16-063 reminds counties of substance use disorder (SUD) services available under EPSDT.
Federal Approvals
SPA 15-034: Updates language regarding Early and Periodic, Screening, Diagnostic, and Treatment and preventive and wellness services.