MA Beneficiaries Turning 21 During the COVID-19 Emergency Continue to Qualify for EPSDT Services
When a child turns 21, they typically “age out” of the child Medical Assistance (MA) health benefit known as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Pennsylvania recently announced that beneficiaries turning 21 on or after March 18, 2020 continue to be eligible for EPSDT services past their 21st birthday, until the end of the month in which the national public health emergency ends.
This means beneficiaries who turn 21 and would otherwise age out of the EPSDT MA benefit, will now be able to continue getting the same scope of services they were entitled to before turning 21. This includes services like eyeglasses, orthodontia, private duty shift nursing, Intensive Behavioral Health Services (IBHS), and more services that are not typically available to adults after they turn 21.
The Pennsylvania Health Law Project is pleased that the state has taken this important step in preserving vital services for children transitioning to adulthood during the COVID-19 pandemic. However, questions remain regarding implementation of this temporary policy change. We will continue to follow up with state officials to determine how families are being notified of this change, and especially how this process will look for youth transitioning to Home and Community-Based Services (HCBS) Waiver programs at age 21 while retaining their EPSDT benefit package. The EPSDT-to-Waiver transition process, as many readers may know, can be fraught with delays and confusion even under normal circumstances.