309.4 MA Services for Children

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.

309.41 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

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:

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.

 

309.42 Early Intervention

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:

 

 

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:

 

For children ages three to entrance into first grade:

 

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)

309.43 Family-Based Mental Health Services

 

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:

 

 

 

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:

 

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.

Reviewed June 25, 2024, Replacing March 12, 2021