EPSDT

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Benefit Plan members under age 21 can get any treatment or health service that is medically necessary to treat, prevent or improve a health problem. This special set of benefits are called Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services.

Members who need EPSDT benefits:

• Can get EPSDT services through their health plan;
• Do not have to pay any copays for EPSDT services; and
• Can get help with scheduling appointments and arranging for free transportation to and from the appointments.

Some EPSDT services may require a prior authorization (PA). To learn more about which services may need prior authorization please call Member Services at 800-444-9137 (TTY: 711) Monday – Friday, 7 a.m. – 7 p.m., Eastern time. EPSDT includes services that can help treat, prevent or improve a member’s health issue, including, but not limited to:

• Health and immunization history;
• Physical exams;
• Various health assessments and counseling;
• Lab and screening tests;
• Necessary follow-up care; and/or
• Applied behavioral analysis (ABA) services.

EPSDT brochure   

Well-being visits

Typically, your child’s doctor will ask you to bring in your child for regular wellness visits. Children enrolled in Go365 for Humana Healthy Horizons® can earn rewards for having well-child visits.

Well-being visits

Children should see their doctors regularly from birth through age 20, to make sure they are and stay healthy.¹ These visits typically occur at birth and when your child is:

• Newborn
• 3–5 days old for newborns discharged less than 48 hours after delivery
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 24 months old
• 30 months old
• Once every year for ages 3–20

These visits help your child’s doctor detect, diagnose, and treat health problems as early as possible.

Well-being visits can include:

• Preventive and comprehensive services
• Physical exams
• Growth measurements
• Immunizations and vaccines
• Vision and hearing screenings
• Dental screenings
• Other important tests and services
• Referrals for diagnosis and treatment, if necessary

Get more information about well-child visits , PDF opens in new window

According to the Centers for Disease Control and Prevention (CDC), “most parents vaccinate their children … protecting them from 14 potentially serious diseases before their second birthday. Vaccinating children on time protects them and anyone around them with a weakened immune system.”²

Vaccines are part of child well visits. Vaccines are free for Medicaid recipients 20 years and younger in Kentucky. Talk to your doctor about what vaccines your child needs depending on his or her age.

View the recommended child and adolescent vaccine schedule for children 18 years and younger

Things change—and the medicine a child takes may need to change, too

During a well visit, a doctor will ask:

• About any medicine that a child takes
• Why the child takes the medicine
• If the child responds well or not to the medicine

You and your child’s doctor will decide together when your child should start or stop taking a specific medicine. This is called deprescribing.

To help make sure your child takes the right medicine at the right time:

• Talk to your child’s doctor
• Keep track of your child’s medicine
• Make sure your child takes medicine as prescribed

Get more information about medicine use in youth

Need help finding a doctor for your child? Use our online Find a Doctor service. You also can call us at 800-444-9137 (TTY: 711).

Remember to:

• Make and keep appointments with your child’s doctor when your child is well, not just when your child is sick
• Talk to your child’s doctor about any concerns you have

Be sure to call your child’s doctor today to set up the next well-being visit.

Children who have well visits can earn rewards through Go365 for Humana Healthy Horizons^®. This is our wellness program that offers you opportunities for earning rewards for taking health actions. Review the list of eligible health activities and available rewards, PDF opens in new window

1. “Early and Periodic Screening, Diagnostic, and Treatment,” Medicaid.gov, last accessed December 9, 2024, https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html.
2. “Reasons to Follow CDC’s Recommended Immunization Schedule,” Centers for Disease Control and Prevention, last accessed December 9, 2024, https://www.cdc.gov/vaccines-children/schedules/reasons-to-follow.html.