Health care, Medicaid & EPSDT

All people, including people with intellectual and/or developmental disabilities (I/DD), should have timely access to high quality, comprehensive, accessible, affordable, appropriate health care that meets their individual needs, maximizes health, well-being and function, and increases independence and community participation. 

Affordable Care Act

Enactment of health care reform, known as the Affordable Care Act (ACA), is the most significant law for people with disabilities since the enactment of the Americans with Disabilities Act (ADA) in 1990. It brings about comprehensive reforms that will benefit Americans with disabilities by prohibiting discrimination based on health status and improving access to care. 

Pages from ACA 1 pager letterhead-Sept.
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Virginia Medicaid

Virginia Medicaid offers several low-cost and no-cost health coverage programs for eligible children, pregnant women and adults, including individuals with disabilities. 

Medicaid for individuals with disabilities

Individuals who are age 65 or older, and/or who are disabled, may be eligible for full-Medicaid health coverage. This, however, is dependent on income and the assets your loved one may have. Certain requirements may be waived if he or she is eligible for a Medicaid Waiver. 

More information on Medicaid for individuals with disabilities may be found by downloading the manual to the right. 

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Resources & links

EPSDT

Early & Periodic Screening, Detection and Treatment (EPSDT) is a federally mandated Medicaid program for children from birth to 21 years of age who qualify for Medicaid. It is sometimes referred to as a "safety net", covering services that are not paid for by Medicaid. EPSDT is a federally-mandated program that is available through all states. 

What services are available?

Some, but not all, services covered by EPSDT include: 

  • Screening; 

  • Vision; 

  • Dental; and 

  • Hearing

EPSDT covers treatments that are typically not available to certain disability groups as well as services that are not covered by the state Medicaid plan. Examples include:

  • Assistive technology; 

  • Hearing & audiology; 

  • Personal care; 

  • Private duty nursing; 

  • Behavioral therapies and treatments; 

  • Specialized inpatient services; and

  • Medical formulas

How to request services & supports through EPSDT

To access EPSDT Specialized Services, the medical provider sends an order to an enrolled service provider chosen by the family. The service provider then obtains a service authorization if necessary.  

Phone: (804)786-6134 

Email: epsdt@dmas.virginia.gov

Resources, documents & links

Pages from EPSDT Fact Sheet.pdf.jpg
EPSDT Assistive Technology Fact Sheet.jp
EPSDT Behavioral Therapy and ABA Service
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© 2023 by The Arc of Northern Shenandoah Valley. 

Tel: 540-692-9650

Email: shenvalleyarc@gmail.com

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