DHS provides a complete health care package for children who qualify for MA. Children can receive all the services for free, no matter what MA category they are in. The focus is on preventive and primary care services. These services identify and treat medical problems early and help each child receive a healthy start in life.
The Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) is a federally funded complete care program. It is the most important part of Pennsylvania's MA program and is free and open to all children under age 21 who qualify for MA.
EPSDT offers regular checkups for eligible children and it pays for medical services, treatments, and follow-up care that the children need.
The program’s services include the following:
Complete health and physical examinations, including checks on each child’s physical and mental development.
Immunizations.
Laboratory tests, including testing of the level of lead in each child’s blood.
Dental, vision, and hearing screenings.
Health education.
The EPSDT program focuses on primary care. Services are available all over the state and are offered by hospitals, physicians, clinics, federally qualified health centers, rural health clinics, community health centers, and certified registered nurse practitioners.
NOTE: See Section 338.61 for information about the CAO’s role in helping individuals enroll in the EPSDT program.
Early Intervention Programs are provided through a collaboration between the Pennsylvania Department of Education (PDE) and the Department of Human Services.
The Office of Child Development and Early Learning (OCDEL) administers the Early Intervention Services for infants to age three. Services are provided by the county Mental Health/Intellectual Development agencies for children from birth to age three.
OCDEL contracts services through county Intermediate Units (IUs), school districts and private agencies to Preschool Early Intervention services to children ages three to entrance into first grade.
Note: Children are coded as EIX in the Home and Community Services System (HCSIS) and in eCIS.
Early Intervention helps children with disabilities develop and learn to their fullest potential. An individualized service plan is developed for each child. A service plan might include any of the following:
Family training and counseling.
Social work services, including home visits.
Speech therapy.
Physical and occupational therapy.
Psychological services.
Technology assistance devices (examples include but are not limited to larger keyboards, joysticks, wands and touch screens.
Medical, nursing, nutrition, vision, and transportation services.
Early Intervention services are available statewide.
The program is free to children up to their entry into first grade, who have an identified developmental delay or disability.
For children birth to age three, the criteria are:
A 25% delay in one or more areas of development, or
A clinical opinion there is a developmental delay, or
A known condition that has a high probability of delay, such as Down’s Syndrome.
For children ages three to entrance into first grade:
A 25% delay in one or more areas of development, or:
Any of the following disabilities, plus a need for special education services:
Autism
Serious emotional disturbance
Neurological impairment
Deafness/hearing loss
Learning disability
Intellectual disability
Multiple disabilities
Physical disability
Speech impairment
Blindness/visual impairment
For more information, call the CONNECT Information Services Helpline for access to early intervention services and information on early intervention and child development. The local Mental Health/Intellectual Disability Program also may offer information and service. (For more information, see Chapter 338, Medical Assistance Benefits, Appendix J)
The Family-Based Mental Health Services program helps families care for children or adolescents with emotional problems. It is designed to keep children out of hospitals and residential placements and to return them to their homes if they already have been removed for treatment.
Services are delivered in the home and community and are governed by the child or adolescent’s and family’s need. They include:
Family and individual therapy
Case Management
Crisis intervention and stabilization
School-based consultation and intervention
Services are available 24 hours a day, 7 days a week. Treatment teams made up of two mental health professionals provide services directly in the home. Services are free and available statewide.
This program is designed for families who have the following:
Children and adolescents up to age 21 who have a mental health diagnosis.
Children or adolescents at risk of psychiatric hospitalization or residential placement.
At least one adult caregiver in the home who agrees to participate in the program.
Certification from a psychiatrist and a psychologist
The program is also available to children who are registered with a local base service unit or mental health center.
There are state-licensed Family-Based Mental Health Services organizations that serve different counties in Pennsylvania.
For more information, contact the PA Department of Human Services, Office of Mental Health, Bureau of Children's Behavioral Health Services, at 717-705-8289.
Updated March 12, 2021, Replacing February 14, 2012