Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), known in Ohio as Healthchek, is a required Medicaid program covering children under age 21. The program requires state officials to periodically screen Medicaid eligible children for health problems. If a child's screening identifies health problems, the law also requires the EPSDT program to provide necessary health care, diagnostic services and treatment. Those services include medical, vision, hearing and lead testing. However, any service that will correct or improve a child's health problems must be provided, if the service is included in a list of federal Medicaid services.
Learn more about EPSDT:
- Important Benefits for Medicaid Eligible Children: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) (DRO publication)
- EPSDT and Title V Collaboration to Improve Child Health (U.S. Department of Health and Human Services, Health Resources and Service Administration)
EPSDT Lawsuit: G.D. v Riley
Ohio Legal Rights Service (LRS) is engaged in active mediation of G.D. v Riley, a class action lawsuit LRS filed against the Ohio Department of Job and Family Services (ODJFS). The case seeks to require the state to comply with federal laws related to the EPSDT program. LRS is co-counseling with Advocates for Basic Legal Equality (ABLE) to prosecute the case. ABLE is a non-profit regional law firm that provides civil legal assistance to low-income clients in 32 counties in Western Ohio.
On March 11, 2011, LRS and ABLE asked the court to rule in favor of the Plaintiffs, Medicaid-eligible children, through summary judgment and find that Ohio’s definition of “medically necessary services” conflicts with federal laws regarding coverage of EPSDT treatment services and results in the denial of treatment services to which these children would be entitled under federal law. LRS asked the court to require the Ohio Department of Job and Family Services, the state Medicaid agency, to remedy violations of federal EPSDT law.
On January 7, 2011, Federal Judge Michael H. Watson of the U.S. District Court for the Southern District of Ohio, Eastern Division, issued an order approving a Consent Decree in partial settlement of G.D. v Riley, formerly G.D. v Lumpkin. The terms of the Consent Decree were effective immediately and will benefit thousands of children in Ohio and their families seeking Medicaid information and services.
Under the terms of the Consent Decree, the director of the Ohio Department of Job and Family Services (ODJFS) will:
- modify administrative rules regarding notification of EPSDT services and the development of informational materials;
- modify managed care agreements to clarify managed care organizations' obligations under EPSDT;
- distribute periodic notifications about EPSDT;
- update information on websites about EPSDT; and
- conduct training and education for state EPSDT staff.
The partial settlement did not include the medical necessity issues in the lawsuit. In the January 7, 2011 Consent Decree, the parties agreed that this remaining issue would be addressed through cross motions for summary judgment, which were filed on March 11, 2011.