Model Medicaid Managed Care Contract Provisions: EPSDT Vision and Hearing Services

Executive Summary

Children enrolled in Medicaid are entitled to a comprehensive array of preventive and ameliorative care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.  As states have increasingly turned to managed care entities to fulfill their Medicaid administrative obligations, these companies are charged with affirmative duties to ensure that children receive EPSDT benefits. This report suggests model contract provisions for coverage of vision and hearing services in Medicaid managed care.