Getting TennCare Services for Children in State Custody

The law promises medical and mental health services for children in, or at risk of entering, State Custody.

Federal and state law say children on TennCare must get medically necessary services. Medically necessary means a doctor or other licensed health care provider says it is needed. What if TennCare says the service or medicine is not covered? If it is medically necessary, TennCare must pay for it.

There is a federal law called EPSDT (Early and Periodic Screening, Diagnosis and Treatment). It tells what services children on Medicaid must get.  In Tennessee the Medicaid program is called TennCare and EPSDTis called TENNderCARE. EPSDT says that children must be screened for any problems and diagnosed appropriately. Children should get health care and other help to treat problems found in the screening. The care should correct or improve physical and mental illnesses.  Children should also get the care they need to keep their physical or mental illness from getting worse, even if it cannot be cured. TennCare, the Department of Children’s Services (DCS), schools and other agencies must work together to provide the services children need.  TennCare must pay for the care even if it is not a TennCare covered service.

All of these groups give TennCare services and must follow EPSDT law:

  • Health care companies, like BlueCross BlueShield;
  • Mental health organizations that cover mental health and addiction;
  • The drug services manager;
  • The dental benefits manager; and
  • DCS and companies that give mental health services to children in state custody.

EPSDT is important for children in juvenile court or State Custody

Most low-income children in juvenile court or DCS custody are on TennCare. Others could get TennCare but have not applied. Sign them up right away through the local office of the Department of Human Services (DHS). Every child on TennCare should get EPSDT services.

How EPSDT can help

Think a child in juvenile court has mental health problems or developmental disabilities?

  • Tell the juvenile court. This information can make a difference in what is decided. EPSDT can make TennCare pay to find out if there is a problem.

Does the child need in-home or school-based mental health services?

  • EPSDT can make TennCare pay for these services.

Has the child been harmed by neglect or abuse? Have the child’s behaviors brought them to juvenile court?

  • EPSDT can get the services needed to help the child with these problems.

How to get EPSDT services for a child in need

1.   Ask the court to tell the child’s doctor to order the service. Is the child not seeing the right kind of health or mental health provider? Don’t know what service is needed? Then get the TennCare health care company to set a time for the child to get an evaluation. What if the child or their parent can’t tell you what plan they are on? You can find out by calling TennCare at 1-866-311-4287 for free.

2.      The health care company won’t approve or get an evaluation scheduled with the right doctor or clinic? The health care company won’t cover a needed EPSDT service? The child has to wait to get the service? Then you can appeal for the child. The Grier lawsuit includes special rights for children in state custody. In some emergencies, you can ask for a quick (expedited) appeal.

To download a printable flyer about services for children in foster care, click here.

If you have questions about how to appeal, read our page on it.