Making Sense of EPSDT: A Practical Guide for Head Start Health Managers and System Admins

If you work in Head Start or Early Head Start, you’ve almost certainly felt the pressure of health mandates:

• “Are we meeting 30/45/90-day requirements?”

• “Does this physical ‘count’?”

• “Why did my EPSDT status go from green yesterday to yellow today?”

EPSDT can feel complicated, especially when you’re juggling different state rules, tight Early Head Start windows, and federal monitoring reviews. This guide is designed to simplify EPSDT and connect it directly to how you work in GoEngage.

What Is EPSDT, Really?

EPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment—Medicaid’s comprehensive child health benefit for youth under age 21. Medicaid: Early and Periodic Screening, Diagnostic, and Treatment Overview

Think of it as the backbone of preventive care:

• Early – Identify concerns as soon as possible so they don’t become crises.

• Periodic – Conduct well-child visits and screenings at recommended ages, not “whenever we get to it.”

• Screening – Include physical, developmental, mental health, vision, hearing, dental, and immunizations.

• Diagnostic – When a screen shows a concern, make sure a proper diagnosis happens.

• Treatment – Provide or connect families to necessary care to correct or improve conditions.

Head Start: Early and Periodic Screening, Diagnostic, and Treatment Overview

For Head Start and Early Head Start, EPSDT aligns directly with HSPPS 1302.42, which requires programs to help families follow recommended well-child and oral health schedules and to monitor ongoing health needs.

In short: EPSDT is the clinical schedule; Head Start is the accountability and follow-up.

One National Schedule – Plus Some State Variations

Most states and territories follow the Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care, often called the Bright Futures Periodicity Schedule.

However, some states have their own customized EPSDT schedule (for example, Arizona, Iowa, Maryland, Massachusetts, Minnesota, Mississippi, Pennsylvania, Rhode Island, Texas, and West Virginia). Head Start collects these in a handy list with links to state schedules.

Action step for programs:

1. Confirm whether your state uses the national Bright Futures schedule or a state-specific EPSDT schedule.

2. Keep a copy of that schedule attached to your internal health procedures and training materials.

3. Make sure your GoEngage EPSDT setup matches that schedule (more on this below).

Common EPSDT Misconceptions (and What’s Actually True)

Several themes show up over and over. Here are the big ones—with how to fix them.

Myth 1: “Mandates only apply at initial enrollment.”

Some agencies believe the 30/45/90-day health mandates only matter when a child first enrolls in the program. After that, they keep using that first enrollment date forever—even years later.

Reality:

The Office of Head Start cares whether children are continuously getting recommended preventive care, not just at first enrollment. This is the ‘E’ and ‘P’ from the EPSDT.

For many screenings (especially for Head Start-age children), mandates are effectively annual, aligned with the EPSDT schedule and the child’s age—not a one-time event.

In GoEngage:

• Initial mandates – 30/45/90-day windows tied to each program year’s enrollment date.

• Ongoing/annual requirements – tied to the child’s age and the EPSDT periodicity schedule.

These work together to maintain continuous health compliance.

Myth 2: “If a child fails a screening (vision, hearing, dental), the event shouldn’t count.”

Some programs think that if a child fails or scores low on a screening, that event should not count toward their EPSDT mandate.

Reality:

EPSDT is asking: “Was this child screened, diagnosed if needed, and connected to treatment?” It is not measuring whether every child passed with perfect scores. As long as the child had the visit/screening, you’ve met the EPSDT requirement. The follow-up and treatment are the next step—not a reason to mark the screening as “doesn’t count.”

This is the ‘D’ and ‘T’ from the EPSDT.

Myth 3: “The physical must be done during the 90 days after enrollment.”

A child receives a physical in April, enrolls in August, and the program assumes the April exam doesn’t count.

Reality:

Under EPSDT/Bright Futures, a well-child visit is generally valid for one year. Pediatricians will not repeat a full exam unnecessarily, just to fit an enrollment window.

GoEngage uses age-based look-back and look-forward windows, meaning:

• A valid exam within the EPSDT window counts toward the mandate.

• As a child ages into the next occurrence (e.g., from 6-month to 9-month), the expectation updates accordingly.

This is especially important for Early Head Start, where age windows change quickly.

Myth 4: “Our in-house screening calendar replaces EPSDT.”

Some programs want the EPSDT schedule customized to match their internal screening days (e.g., physicals or screenings for everyone in August–September)—or want mandate windows extended because staff don’t have enough capacity.

Reality:

You can add extra in-house screenings and events, but you can’t override the EPSDT standard itself. HSPPS and EPSDT requirements still apply, regardless of internal constraints. HSPPS: 1302.42 Child health status and care

GoEngage can support your workflow by:

• Adding additional screening events

• Adjusting allowable windows (when permitted)

• Maintaining EPSDT compliance without modifying federal expectations

Myth 5: “Early Head Start behaves just like Head Start.”

Early Head Start is a different world. For infants and toddlers, EPSDT windows are very small and children age up quickly.

Reality:

Early Head Start is far more time-sensitive.

• Age windows are narrow.

  • A child might move from “6-month” to “9-month” expectations within the same 90-day mandate window.

• Children age into new EPSDT expectations quickly.

  • You may see statuses change (green → yellow → red) overnight simply because the child aged into a new EPSDT window, not a data error.

This isn’t a bug—it’s the system correctly following the age-based periodicity schedule.

How GoEngage Supports EPSDT Compliance

Here’s how EPSDT translates into practical workflows in the system.

1. Confirming the Right EPSDT Schedule

GoEngage’s EPSDT configuration:

• Is maintained by Support

• Reflects Bright Futures or your state-specific schedule

• Includes look-back windows, occurrences, and age-based timing

✔ Quick Win

If your state updates its EPSDT schedule—or if something seems off—request a review:

“Please review our EPSDT setup against the current [State] EPSDT/HealthCheck schedule.”

For multi-state or migrant programs, you must determine which schedule will be used for the agency.

2. Understanding Mandates vs. Occurrences

GoEngage tracks EPSDT using:

Mandates (initial enrollment requirements)

• 30/45/90-day expectations

• Color coding: yellow (upcoming), red (overdue)

Occurrences (ongoing age-based requirements)

• Follow EPSDT periodicity by age- only one event per age(e.g., 3-, 6-, 9-month)/year (3, 4, 5 year) is required

• Occurrence windows determine whether a past exam counts

Look-Back Windows

A past exam may still count if performed within the allowable EPSDT window.

Most common confusion:

If a child’s status suddenly changes color, it’s almost always because they aged into a new occurrence window.

When staff ask, “Why is this still green?” or “Why did it turn yellow?”, the answer is almost always in the occurrence window and the child’s age.

3. Monitoring EPSDT Data in GoEngage

a. Use My Health Workbook

Best for daily or weekly monitoring:

• Switch between Initial Mandates and Ongoing views

• For EHS, prioritize Ongoing, since infants and toddlers age out of windows quickly.

• Use filters (site, classroom, funding source) to prioritize which groups need attention.

b. Use POP (Program Outcomes Portal) for the big picture

Best for big-picture oversight:

• Track initial 30/45/90-day requirements

• View ongoing age-based EPSDT status

• Ideal for Focus Area reviews and leadership reporting

Summary of Head Start Health Services Year-at-a-Glance:

Head Start requires programs to complete key health tasks based on each child’s enrollment date—collecting health histories and consents at enrollment; confirming insurance and medical/dental homes within 30 days; completing vision and hearing screenings within 45 days; and obtaining physicals, dental exams, and EPSDT-required screenings within 90 days. Throughout the year, programs must keep children up to date on EPSDT care, monitor for new health or developmental concerns, support families in accessing services, and follow up on any identified needs. Additional requirements include supporting health-related transitions, providing prenatal/postpartum services for pregnant women, conducting health and safety trainings, completing ongoing monitoring and reporting (including PIR), and annually reviewing policies, goals, and community needs.

c. Set Up Alerts

You can set alerts to notify staff about upcoming or overdue events:

• Configure weekly alerts (recommended for EHS and mixed programs) or monthly alerts (HS-only) to show upcoming and past-due health events.

• Alerts can go to health managers, system admins, family advocates, etc., so the right people know which families need reminders.

• POP groups allow bulk emails/texts to families

✔ Quick Win:

Directors who want monthly visibility (without weekly alerts) can receive a scheduled monthly report instead.

Partnering With Families: Helpful Resources to Share

You don’t have to explain EPSDT from scratch to every family. Bright Futures, AAP, CDC, and Head Start have already created excellent materials you can link or print: AAP

Consider including in your family packets or parent meetings:

• “The Well-Child Visit: Why Go and What to Expect” – plain-language overview of why regular checkups matter (English and Spanish).

• HealthyChildren.org – AAP’s website for parents, with guidance by age, health topics, and parenting challenges.

• CDC Milestone Tracker App and milestone checklists – easy tools to help parents watch developmental milestones and know when to talk with the doctor.

• Head Start health and wellness pages – resources on medical homes, oral health, and family engagement.

These tools reinforce the message that EPSDT isn’t just paperwork—it’s about keeping children healthy and ready to learn.

Quick EPSDT & GoEngage Checklist

Use this mini self-audit to see where your program stands:

☐ We know whether we follow the Bright Futures schedule or a state-specific EPSDT schedule.

☐ Our GoEngage EPSDT configuration has been reviewed against that schedule in the last 12–18 months.

☐ Health managers and system admins both understand the difference between initial mandates and ongoing/annual occurrences.

☐ Staff know that “failing” a screen still counts as meeting the mandate, as long as the child was seen and is receiving treatment.

☐ Early Head Start staff understand that narrow age windows mean children may need more frequent screenings and their status may change as they age up.

☐ We monitor EPSDT using My Health Workbook and POP on a weekly or monthly basis.

☐ We have alerts turned on for upcoming and past-due health events, and they go to people who will take action (health managers, family advocates, etc.).

☐ Directors receive a regular high-level report summarizing EPSDT compliance.

☐ We share at least one family-friendly resource (e.g., Well-Child Visit tip sheet, HealthyChildren.org, CDC milestones) with families each year.

Need Support Navigating EPSDT? We’re Here to Help.

EPSDT can feel complex, but you don’t have to navigate it on your own. Whether you need help understanding your state’s schedule, configuring GoEngage correctly, or building a realistic monitoring process for your team, we’re here to support you. Our training and consulting services are designed to meet you where you are and give your program the tools to thrive.

👉 Ready for guidance or hands-on training?

Contact us to get started.