HEALTHY KIDS (EPSDT)

The federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) preventive health care benefit is called Healthy Kids in Washington State. The purpose of this program is to identify health, mental health, and substance abuse problems in Medicaid clients 20 years of age and under, and to provide appropriate services to treat any identified medical, mental health and substance abuse issues.

Effective April 1, 1995, EPSDT was folded into King County's Mental Health Plan (MHP) which covers outpatient mental health services for Medicaid eligible and a portion of non-Medicaid individuals (75/25 percent ratio for children). The MHP administers funding for contracted mental health services through a vendor network. In the MHP model there are five levels of care within three tiers.A level of care is based on medical necessity criteria which in turn are based on an individual client's needs.

A person can enter the mental health EPSDT system through many doors including, but not limited to self referral, parent or guardian, school, physician, therapist, mental health or other agency. Upon initial entrance into the mental health system, in order to be eligible for Medicaid EPSDT services, two things are required:

1. A Mental Health Assessment must be done by a local MHP mental health provider. The mental health assessment is based on medical necessity criteria, defined as clinical criteria which determine the level of care and specific outcomes, based on a child's individual needs.
2. The child's doctor needs to perform an EPSDT Medical Exam if one was not done within the previous year. Written authorization by the doctor for mental health services is also needed.

For further information regarding Healthy Kids (EPSDT), please contact the MHP at 1-800-790-8049.