The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is a federally mandated benefit under Title XIX of the Social Security Act. This benefit provides preventive and comprehensive health services for Medicaid-eligible individuals under age 21. The EPSDT benefit is provided to Medicaid-eligible infants, youth and participants up to the age of 21. The primary goal is to offer prevention, early diagnosis and medically necessary treatment of conditions.
The following forms are available for download. You will need Adobe Acrobat Reader to view these files.
- DHS 8015 Form (Rev. 01/10) Hawaii Early and Periodic, Screening Diagnosis, and Treatment (EPSDT) Exam
- DHS 8016 Form (Rev. 01/10) Hawaii Early And Periodic, Screening, Diagnosis, and Treatment (EPSDT) Immunization Catch Up & Follow-Up form
Hawaii CMS 416 Submissions