EPSDT services ensure that children receive early detection and care, so that health problems can be diagnosed, and treatment be provided as early as possible.

Children may go to a doctor, a nurse practitioner or a physician’s assistant for a well-child exam. Children do not need to have a specific complaint to be seen. New Mexico has adopted the examination and screening guidelines recommended by the American Academy of Pediatrics (APP) and Bright Futures.  

Detailed information regarding periodicity schedule, anticipatory guidance and screening tools can be found at: https://brightfutures.aap.org/Pages/default.aspx

Federal regulations require that providers review a child’s development at every well child visit to include the following:

• Medical history 
• Measurements of height, weight and BMI
• Unclothed physical examination
• Nutrition screening
• Vision and hearing screenings
• Developmental/behavioral assessment
• Hematocrit/hemoglobin at 9 months and 13 years
• Lead screening at 12 months and 24 months
• Immunizations
• Selective screenings necessary according to risk factors
• Anticipatory Guidance​​

When an examination or screening indicates the need for further evaluation, the child should be appropriately referred for diagnosis and treatment without delay.  EPSDT services listed in Section 1905(a) of the Social Security Act are covered if that treatment or service is determined to be medically necessary to correct or ameliorate defects and physical and mental illnesses or conditions. This includes:

• Physical health
• Behavioral health
• Speech/language and occupational therapies
• Home health services
• Medical equipment and supplies
• Vision, hearing, dental, and much more. 

This broad coverage requirement results in a comprehensive, high-quality health benefit for children. EPSDT Benefit covers diagnostic and treatment services that ameliorate conditions.

These other benefits include but are not limited to:

• Early intervention for developmental delays
• Hospital services
• Vision and hearing services
• Dental care
• Physical, occupational, and speech therapy
• Laboratory tests, X-rays, and other imaging tests
• Pharmacy services (including some over-the-counter medicines)
• Medical supplies
• Prosthetics and orthotics
• Nutrition consultations
• Reproductive health care
• Home health and personal care services
• Case management
• Outpatient mental health testing and counseling
• Psychiatric hospital services
• Residential treatment

Please contact us with any questions, concerns and/or comments at MADInfo.hsd@hsd.nm.gov 

The EPSDT benefit covers a wide range of services. To access additional services for children with special needs HSD offers additional wraparound benefit programs. For more information please visit the Developmentally Disabled Waiver and Medically Fragile Waiver page.

New Mexico Department of Health provides early intervention services to over 14,000 children age birth to three who have or who are at risk for developmental delay, and their families.

75% of New Mexico’s births are covered by Medicaid and now, beginning January of 2024, continuous health insurance coverage has been extended to children from birth to age six, benefiting 92,842 children. This change eases the administrative burden on families by eliminating the need for annual Medicaid renewals for children from birth to age six — we are ensuring uninterrupted access to essential health care services for our youngest New Mexicans.

Fostering family wellness and child development from the comfort of the home is a priority for New Mexico. Having more home visiting providers in the Medicaid program broadens the support network for new families, offering crucial assistance during pregnancy and post-birth.  

The Medicaid Home visiting program has been expanded to more providers, offering important early support to new families during pregnancy and post-birth. This approval allows additional home visiting providers to enroll in the Medicaid program, expanding options for new families to gain important support during pregnancy and after birth. These services include prenatal and postpartum care, infant care, health and nutrition guidance, and child development support. 

These approvals are part of a larger initiative to bolster maternal and child health in New Mexico.  Federal approvals that start in January 2024 also include enhancements to existing programs such as: 

• Community Benefit, allowing in-home services for Medicaid customers. 
• Expanded services through the Linkages program, supporting individuals with substance misuse disorders. 
• Authority for legally responsible individuals, such as parents, to be paid caretakers for children receiving certain Medicaid services. 

The department expects more approvals in 2024 for initiatives targeting health-related social needs, such as Medicaid coverage for incarcerated individuals during the pre-release period, housing initiatives with respite programs for unhoused individuals, and food as medicine programs for nutritional support to specific Medicaid populations.