Resource Details

State Definitions of Medical Necessity Under the Medicaid EPSDT Benefit

07/15/2021 9:26am
Catalyst Center

State Medicaid programs are required to provide Medicaid enrollees under age 21 with comprehensive and preventive health care services through the Early Screening and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Federal law requires states to cover “medically necessary services” under the EPSDT benefit “whether or not such services are covered under the State plan.” This resource presents definitions of medical necessity from all 50 states and the District of Columbia.

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