MassHealth’s Early and Periodic Screening, Diagnostic and Treatment Benefit

The federal government requires each state Medicaid agency to provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. MassHealth’s EPSDT benefit makes sure that children, teens, and young adults have access to the preventive, dental, behavioral health, and specialty services they need. All MassHealth Standard and CommonHealth members younger than 21 are covered.

If you are a MassHealth Family Assistance member younger than 21, please visit the Preventive Pediatric Health Care Screening and Diagnosis (PPHSD) Benefit page.

If you are a provider, please visit the EPSDT and PPHSD Information and Resources page.

What is included in the EPSDT benefit?

The MassHealth EPSDT benefit covers

• preventive care, such as well-child and dental checkups; and
• services to diagnose, treat, or manage a medical, hearing, vision, dental, or behavioral health condition.

Services provided under the EPSDT benefit are free (except for any MassHealth premiums you may pay). All coverage is subject to the conditions and limitations of MassHealth regulations.

The EPSDT benefit includes all services covered under federal Medicaid law that are medically necessary, even if those services are not already covered by MassHealth or your health plan.

• Medically necessary means that the services are needed to diagnose, treat, manage, or improve an illness or health condition.

For some services, your provider may need to submit a special request, called a prior authorization (PA) request. MassHealth or your health plan will review the PA request to determine if there is a medical need for the service. They will then approve or deny the request.

• If you have questions about the PA process, you can
  • talk to the provider submitting the request,
  • contact your health plan, or
  • contact MassHealth.
• If you disagree with a decision to deny a prior authorization request, you have the right to appeal the decision. Refer to your member handbook or contact My Ombudsman for help.

How to receive benefits

MassHealth members may receive their benefits in one of two ways.

1. A health plan is usually responsible for managing your care on behalf of MassHealth.

• If you have a health plan, you should have received a health plan ID card. Your ID card includes your health plan’s customer service number. You can also call the MassHealth Customer Service Center at [phone], TDD/TTY: 711.

• Learn more about the different types of MassHealth health plans available in the MassHealth Enrollment Guide.

2. In some cases, MassHealth directly manages your benefits.

• You will only receive a MassHealth ID card and should call MassHealth Customer Service for help at [phone], TDD/TTY: 711.   

Covered Services for EPSDT-eligible MassHealth members

For members with the EPSDT benefit, MassHealth covers well-child and dental checkups and services needed to diagnose, treat, or manage a medical, hearing, vision, dental, or behavioral health condition. Your primary care provider can help you get any other services that are medically necessary for you. For a more comprehensive list of covered services, refer to your member handbook and the MassHealth covered services chart. 

Well-child checkups

It’s important for children, teens, and young adults to get regular checkups (also known as well-child checkups) with their primary care provider. Small problems that are found early can be taken care of before they become bigger problems. If you need help finding a primary care provider, you can call your health plan or the MassHealth Customer Service Center at [phone], TDD/TTY: 711.

MassHealth recommends well-child checkups at the following ages (based on guidance from the American Academy of Pediatrics).

• Before Age 1: Newborn (may occur in the hospital before discharge), 3–5 days, by 1 month, 2 months, 4 months, 6 months, and 9 months
• Ages 1–2 years: 12 months, 15 months, 18 months, 24 months, and 30 months
• Ages 3–21 years: Once per year

What happens during a well-child checkup?

During a well-child checkup, your primary care provider should do a full physical exam. They should also do the following.

• Ask about your health history, including
  • family history;
  • birth, growth, and nutrition history;
  • medications you take or have taken;
  • allergies, including medication allergies; and
  • medical history, including past illnesses.
• Make sure your immunizations (also called vaccines or shots) are up to date.
  • Immunizations are a safe, effective way to prevent many diseases, hospitalizations, deaths, and even some cancers.
  • Different immunizations are recommended at different ages. Some, like flu shots and COVID-19 boosters, may be needed every year to stay protected.
  • MassHealth covers immunizations provided at the doctor’s office and at other locations. You can call the MassHealth Customer Service Center at [phone], TDD/TTY: 711 or your health plan for help finding the best place to get your shots.
• Measure height and weight.
• Check blood pressure (usually starting at age 3 and then every year).
• Check hearing and vision (usually starting at age 3 or 4 and then at later well-child checkups).
• Conduct age-appropriate developmental and behavioral health screenings, including screening for
  • depression in parents and other infant caregivers (through the child’s 12-month visit);
  • Autism Spectrum Disorder (at 18 and 24 months);
  • development (at 9, 18, and 24 months, and as needed);
  • tobacco, alcohol, and drug use (beginning at age 11); and
  • depression (beginning at age 12).
• Check dental health and, if needed, apply fluoride varnish (a treatment that helps prevent tooth decay). 

Behavioral health services

As part of the well-child checkup, your primary care provider should offer to assess your child’s behavioral health needs. To do this, they will use a screening tool with a short list of questions. These questions can be completed by a parent, teen, or young adult. You and your primary care provider can talk about your answers to decide if follow-up behavioral health care is needed.

MassHealth covers short-term preventive behavioral health services, such as

• individual or family therapy,
• group therapy, and
• caregiver support for children who screen positive for a behavioral health need, even without a formal diagnosis.

You don’t need a referral to get most behavioral health services. Your primary care provider can help you find a behavioral health provider who is right for you.

MassHealth covers many behavioral health services for children, teens, and young adults. These services include the following.

• Outpatient therapy (individual or group setting)
• Services provided through the Children's Behavioral Health Initiative (CBHI). CBHI helps MassHealth children and their families with behavioral, emotional, and mental health needs. It provides services like in-home therapy; in-home behavioral support; therapeutic mentoring; family support and training; and intensive care coordination.
• Inpatient behavioral health services (24-hour hospital services for mental health and substance use disorder diagnosis and treatment)
• Residential rehabilitation services for substance use disorders
• Outpatient opioid treatment services
• Applied behavior analysis for children who have autism spectrum disorder
• 24/7 crisis services for immediate mental health or substance use disorder help
• 24/7 access to mobile crisis teams that can come directly to you
• Other medically necessary behavioral health services

Many behavioral health services can be accessed at Community Behavioral Health Centers (CBHCs), which are one-stop shops for a wide range of mental health and substance use services and treatment, including outpatient services and 24/7 in-person crisis support services. The statewide network of CBHCs offer immediate, confidential care for mental health and substance use needs. Find a CBHC near you.

Physical health services

In addition to well-child checkups, you may need other physical health services to diagnose, treat, or manage a medical problem. MassHealth covers many physical health services, including the following.

• Laboratory services (such as blood testing)
• Hearing services (such as hearing loss testing and hearing aids)
• Radiology and diagnostic services (such as X-rays)
• Pharmacy services (such as medications and medical supplies)
• Reproductive health services (such as family planning counseling, birth control, and abortion care)
• Specialists (such as cardiologists and neurologists)
• Therapy services (such as occupational therapy and physical therapy)
• Early Intervention services (to support children up to 3 years old who have a developmental delay or are at risk of a developmental delay)
• Durable medical equipment (such as mobility equipment and hospital beds)
• Home health services (such as skilled nursing)
• Other medically necessary physical health services

Dental checkups and other dental services

MassHealth recommends dentist visits every six months. Babies should start seeing the dentist when their first tooth comes in, or by the time they turn 12 months old. MassHealth covers many dental services if they are provided by a dentist who accepts MassHealth. Such services include the following.

• Cleanings
• X-rays
• Braces
• Fillings
• Crowns
• Root canals
• Extractions (tooth removal)
• Oral surgery
• Other medically necessary dental services

For more information on MassHealth dental coverage or to find a dentist, you can call Dental Customer Service at [phone], TDD/TTY: 711, or visit Learn about MassHealth dental benefits.

Vision services

As part of a well-child checkup, your primary care provider should check your vision for general eye health and screen for any vision problems, as needed. If you need follow-up care, your primary care provider should refer you to a vision care provider. MassHealth covers many vision services, including the following.

• Annual eye exams
• Eyeglasses
• Prescription updates to eyeglass lenses
• Other medically necessary vision services

For more information on MassHealth vision coverage, you can

• call your health plan,
• call MassHealth Customer Service at [phone], TDD/TTY: 711, or
• visit Learn about MassHealth vision care services.

Transportation to Health Care Services

Transportation services may be provided to and from non-emergency medical appointments, including well-child checkups and dental appointments. If you have transportation needs, talk to your provider.

Your provider must complete a Request for Transportation before you can schedule transportation. Parents, family members, and caregivers/guardians accompanying you to the appointment may join the ride. Transportation may also be available for parents, family members, or caregivers/guardians who need to participate in treatment for the direct benefit of the child but live at a different address or have a child staying in a residential facility.

Who qualifies for transportation services?

MassHealth members who are in MassHealth Standard, MassHealth CommonHealth, or MassHealth CarePlus coverage types and are unable to access public transportation or private means of transportation are eligible for non-emergency medical transportation services.

Learn about non-emergency medical transportation for MassHealth members.

Resources

Questions?

All members can call the MassHealth Customer Service Center at [phone], TDD/TTY: 711. If you have a health plan, you can also call the customer service phone number on your health plan ID card.

For information about disability accommodations, language assistance, and other communication help, visit Communicating with MassHealth.

Other Resources

• To find out more about MassHealth for children, visit MassHealth for children and young adults.
• My Ombudsman is an independent program for all MassHealth members. My Ombudsman can help if you have questions or need help getting benefits or services from MassHealth or your MassHealth health plan. They provide information about MassHealth benefits and rights, listen to concerns, and help address problems. My Ombudsman can also explain how to file a grievance or appeal, but they cannot represent members in these processes.
  • For more information, visit My Ombudsman. You can also email [e-mail], call [phone], or connect by videophone at [phone] (for Deaf and Hard of Hearing members).
• The Women, Infants, and Children (WIC) Nutrition Program provides free nutrition and health education, healthy food, and other services to pregnant and breastfeeding people and to infants and children under age five. For more information about WIC, call [phone], TDD/TTY: 617-624-5992 or visit the WIC webpage.
• For information about resources available through the Department of Transitional Assistance, including direct economic help (cash benefits) and food help (SNAP benefits), call [phone] or visit the DTA webpage.

Date published:	July 18, 2025