309.5 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.

309.51 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.

309.52 Other Services for Children

Besides providing services through the EPSDT program, the DHS has the following programs that offer MA benefits for children. (See Appendix A for a complete list of benefits.)

309.521 ACCESS Plus

What is the program?

 

ACCESS Plus provides physical health services to eligible MA recipients who are not enrolled in a voluntary Managed Care Organization (MCO) in the 42 Pennsylvania counties not serviced by HealthChoices.   ACCESS Plus includes enhanced Primary Care Case Management and Disease Management.

Enrollees of ACCESS Plus have:

 

Who qualifies?

 

The following individuals will be enrolled in ACCESS Plus:

 

 

Additional Information regarding ACCESS Plus can be obtained by contacting the ACCESS Plus Helpline.  (See Chapter 338, Medical Assistance Benefits, Appendix J

309.522 Early Intervention

What is the program?

 

Services through Early Intervention identify and focus on developmental delays, children’s disabilities, and special needs of children and their families. A service plan developed for the child might include any of the following:

Early Intervention services are available statewide.

Who qualifies?

 

The program is free to children up to age 3 who have an identified delay or disability in at least one of the following areas:

 

Where can I receive more information?

 

For more information, call the CONNECT Hotline 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)

309.523 Family-Based Mental Health Services

What is the program?

 

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.

 

An important part of the program is the focus on families as partners and resources in treatment. The program uses a thorough approach and is 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.

 

Who qualifies?

 

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.

Where can I receive more information?

 

For more information, contact the PA Department of Human Services, Office of Mental Health, Bureau of Children's Services, at 717-787-3458 or 717-787-3459.

Updated February 14, 2012, Replacing February 8, 2002