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On October 26, 2005, Ohio Legal Rights Service (OLRS) filed a lawsuit in federal court on behalf of children who are eligible for but are not receiving needed medical services under the state's Medicaid program. The class action complaint is brought against the director of the Ohio Department of Job and Family Services (ODJFS) on behalf of a class of Medicaid eligible children who are being denied the benefits of Ohio's Early and Periodic Screening Diagnosis and Treatment (EPSDT) program.
This booklet is protected by copyright under United States law and by international copyright laws and treaty provisions. You may copy and distribute the work provided that you use the work for personal, noncommercial use; do not add the work to a collection or use it with any other text, photographs, artwork, etc; do not modify or alter the work in any way or delete or modify any copyright; and do not publish or post all or any part of the work on any Internet site or in or on any other media without obtaining the prior written consent of Ohio Legal Rights Service. Copyright © 2006 Ohio Legal Rights Service. All rights reserved. What is EPSDT?EPSDT, known in Ohio as Healthchek, is a required Medicaid program covering children under age 21. This program requires that state officials periodically screen Medicaid eligible children for health problems. If a child's screening identifies health problems, the law also requires the EPSDT program to provide necessary health care, diagnostic services and treatment. Those services include medical, vision, hearing and lead testing. However, any service that will correct or improve a child's health problems must be provided, if the service is included in a list of federal Medicaid services. This is true even if the service is not routinely covered by Ohio's Medicaid plan.
What kinds of services can be provided through EPSDT?There is a list of 27 services under federal Medicaid that can be provided under EPSDT. That list includes:
How do I get EPSDT services for my child?OLRS filed the lawsuit in part because there is no clear process for a parent to apply for EPSDT services. OLRS recommends that you take the following steps to try to access EPSDT services.
Who pays for EPSDT services?The law requires that the Ohio Department of Job and Family Services (ODJFS) (Ohio's Medicaid Agency) provide or arrange for EPSDT services. If the service your child needs is available through an existing program, that program can be utilized. If an existing program is not available and your child needs a Medicaid covered service, then ODJFS is required to fund that service. The service will be paid for through federal and state dollars (known as "state match"). In the past, many children received services (including therapies and psychological services) under the Community Alternative Funding System (CAFS) program. The state voluntarily ended that program on June 30, 2005. The CAFS program received funding from the federal government, along with match from local county boards of mental retardation/developmental disabilities or local school districts to provide theses services. Although the CAFS program is gone, a child needing therapy services previously covered under CAFS is still entitled to necessary services which the state Medicaid agency must fund if other funding is not available. As discussed above, Medicaid is a federal and state funded program in which the federal government pays approximately 60 percent of the cost of a service and the state pays approximately 40 percent. In Ohio, some of the Medicaid programs (including CAFS) have utilized local money for the 40 percent state share. However, ODJFS cannot deny a necessary service to your child if there is no local money for the state share. What can I do if I cannot access services through EPSDT?Clearly document the steps you took to try to access EPSDT services. Document whether you were successful or unsuccessful in getting services. You should keep copies of any letters you wrote and any letters or evaluations you have. You should also keep written records of any telephone calls you made including who you talked to and what you talked about and the date of your conversation. Contact OLRS and tell us your experience: Ohio Legal Rights Service Funding for this PublicationFunding for this booklet was provided by the Administration for Developmental Disabilities of the U.S. Department of Health and Human Services. Ohio Legal Rights Service does not discriminate in provision of service or employment because of race, color, religion, sex, sexual orientation, national origin, military service, disability, or age. Related Topics:
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