Special Services for Children in TennCare

Children up to age 21 enrolled in TennCare have a legal guarantee to diagnosis and treatment under the Medicaid program known as EPSDT (early and periodic screening, diagnosis, and treatment). EPSDT services include:

• free immunizations
• free medical screens
• free vision screens
• free dental screens, and
• any free treatment that is medically necessary to correct any physical or mental illness discovered during a screen.

Federal law also requires the MCOs and BHOs to inform you about what screens and services are available for your child and how to get these services. Also, they must,, help you with scheduling and transportation for your child to receive screening or treatments, if you request it.

TennCare providers (the MCOs and BHOs) are required by law to pay for health services that provide "maximum reduction of physical or mental disability and restoration of a child to his best possible functional level."

All TennCare plans must cover more than hospital and doctor care. They must pay for:

• case management
• personal care
• rehabilitation (including speech therapy, physical therapy, and mental health rehabilitation)
• medical equipment
• home health care
• private duty nursing
• respirator care
• organ transplants
• hospice care, and
• any other type of remedial care recognized by state law and performed by licensed providers.