when appropriate. Vision services must be provided according to a distinct, separate periodicity schedule developed by the state and at other intervals as medically necessary. Hearing At a minimum, hearing services include diagnosis and treatment for defects in hearing, including hearing aids. Speech, language, and hearing services are related and are covered when medically necessary. Mental Health Children’s mental health services are an integral part of the design and scope of EPSDT. From behavioral/social/emotional screening tests as part of EPSDT well-child visits, to diagnosis, to treatment, and systems of care, Medicaid and EPSDT are critical to financing evidence-based mental health services for children. Federal law requires comprehensive well-child examinations with screening services through EPSDT, including screening for potential developmental, mental, behavioral, and/or substance use disorders. Where states choose, requiring providers to use objective and standardized tools to assess mental/behavioral/social/emotional health make the process more effective. EPSDT also finances diagnostic and treatment services, if medically necessary, for these conditions. Some states contract with managed care organizations or community mental health centers to deliver certain Medicaid financed services for children, and in other states Medicaid financing for children’s mental health services is administered by state mental health agencies. State Implementation Federal law requires that children under age 21 who are enrolled in Medicaid be entitled to EPSDT benefits and that States must cover a broad array of prevention and treatment services. In turn, states have responsibility for certain policy implementation decisions. For example, states determine provider qualifications, set payment levels, create benefit definitions, and make medical necessity determinations. As state Medicaid agencies adopt managed care approaches, Medicaid has evolved. Early studies of Medicaid managed care indicated that children may have received fewer visits or services. More recent studies point to states use of quality improvement projects, improved contracts, and other mechanisms which can optimize care. How states implement and manage EPSDT is important to millions of children, particularly the youngest and most vulnerable. To conform with the prevention and early intervention goals of the program, states need to ensure coverage of development screening, optimize the frequency of covered visits, and offer incentives to provide comprehensive, age-appropriate care. Where states have failed to implement EPSDT law, families have sometimes brought lawsuits in an effort to secure a remedy. Barriers to Care Expanding health coverage for low-income since the mid-1980s has made a significant contribution to their appropriate use of health services and to