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ForwardHealth: The HealthCheck Benefit Helps Children and Young Adults Stay Healthy

HealthCheck is a Medicaid health care benefit created for young people. The goal is to prevent illnesses and find and treat health issues early. HealthCheck is Wisconsin’s name for the federal benefit called Early and Periodic Screening, Diagnosis, and Treatment.

The benefit covers exams and certain special services or products for those under 21 who have:

The HealthCheck well-child exam

You don’t need to fill out any forms for HealthCheck. You just need to call your doctor and schedule a HealthCheck well-child exam. The benefit provides regular, quality health care until age 21.

These exams are doctor visits you schedule when the child in your care is well. The doctor asks questions and examines your child. This is to make sure your child is healthy and taking the right steps to stay healthy. It’s a good time to ask health questions you or your child may have.

The exams follow guidelines from the American Academy of Pediatrics’ Recommendations for Preventive Pediatric Health Care Periodicity Schedule (PDF).

The HealthCheck well-child exam includes:

  • Dental checks.
  • Growth and development checks.
  • Head-to-toe physical exams.
  • Health information.
  • Hearing and vision checks.
  • Lab tests.
  • Nutrition checks.

During these exams, the doctor looks for:

  • Diabetes.
  • Ear or eye problems.
  • Growth and developmental milestones.
  • Mental, emotional, or substance use problems.
  • The need for tests or vaccines.
  • Tooth decay.
  • Sickle cell disease.
  • Stomach problems.
  • Other medical problems.

 

 

An eye doctor using a phoropter.

Eye exams

 

A child's hearing is being tested.

Hearing checks

 

A dental hygienist putting a bite-blocker in a child's mouth.

Dental exams

Costs for a HealthCheck well-child exam

There is no cost for a HealthCheck exam. Just show your ForwardHealth card at your doctor visit. HealthCheck also covers follow-up visits or appointments with other doctors if there are health or development concerns. If your child receives more services than a well-child exam at their visit, you may need to pay a deductible or copay.

To learn what services HealthCheck covers, ask your doctor or call ForwardHealth Member Services at 800-362-3002 between 8 a.m.–6 p.m., Monday through Friday.

HealthCheck “other services”

If your child is under 21 and needs a service Medicaid typically doesn’t cover, you may be able to use a benefit called HealthCheck “Other Services” to cover it.

To do so, the service must be:

  • Able to be covered according to federal Medicaid law.
  • Deemed medically necessary by ForwardHealth.

It includes services such as:

  • Dental care.
  • Home health services.
  • Medical equipment and supplies.
  • Medicines.
  • Physician services.
  • Therapies.

Your doctor will write a prescription for the service or product your child needs.

How to get HealthCheck “other services”

  1. Schedule a HealthCheck well-child exam with a doctor.
  2. If the doctor finds an illness or condition during the exam, they will write a prescription for the service or product your child needs. They can also help you with where to get the service or product.
  3. The doctor will send the prescription to ForwardHealth with information that explains what your child needs and why. This is called a prior authorization request.
  4. ForwardHealth will look at the request and decide if it is medically necessary.
  5. If ForwardHealth agrees that it’s medically necessary, it will cover the service or product.
  6. ForwardHealth will let the doctor who made the request know its decision. The doctor will then contact you.

If the request wasn’t approved, it was either denied or approved with changes. “Approved with changes” may mean a lower prescription dose, for example. Your doctor should be able to explain the reason for the decision.

You have the right to appeal. Follow the directions in the letter you received about fair hearing rights.

Help with scheduling and getting to doctor visits

If you need help making a doctor visit, call ForwardHealth Member Services at 800-362-3002.

If you need a ride to a doctor visit, call 866-907-1493 or visit our non-emergency medical transportation page. You may be able to get a ride, bus tickets, or money for gas.

Related topics

Resources for county waiver agencies and providers

 

 

This information is in accordance with Wis. Admin. Code § DHS 107.22 Early and Periodic Screening, Diagnosis, and Treatment services.

Last revised February 13, 2023