HealthCheck: Preventive Health Care for Children and Young Adults Through Age 20

The HealthCheck benefit helps children and young adults stay healthy

  • HealthCheck is a Medicaid health care benefit especially created for young people.
  • HealthCheck covers in-depth exams and checkups. It also covers specialized services or products your child may need under HealthCheck "Other Services."
  • Anyone under 21 who has Medicaid, BadgerCare Plus, or a ForwardHealth card is automatically covered. There are no forms to fill out. All you need to do is call your doctor and make an appointment for a HealthCheck well-child exam.
  • During a HealthCheck well-child exam, all parts of your child’s health and development are looked at.
  • The goal of HealthCheck is to prevent illnesses and find and treat health issues early.
  • This benefit is called EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) in federal Medicaid publications.

Do you need help scheduling doctor visits?
Call ForwardHealth Member Services at 800-362-3002.

Do you need rides to and from your appointments?
Wisconsin's non-emergency transportation services can help you get a ride, bus tickets, or money for gas. Call 866-907-1493.

 

Watch this video created for providers to learn more about HealthCheck.

You, your doctor, and HealthCheck all work together to support your child's health

Keeping your child healthy is one of the most important things you can do, and young adults need to be proactive with their health care, too. Your doctor keeps track of your health information, including HealthCheck. The HealthCheck benefit provides continuous, quality health care until age 21. The first step in working together is to schedule a HealthCheck exam with your doctor. Then, HealthCheck exams are scheduled on a regular basis using guidelines developed by the American Academy of Pediatrics (PDF).

HealthCheck well-child checks are regularly scheduled exams

HealthCheck exams, also known as "well-child checks," are doctor visits you go to when you are well. They are where you find out how to stay healthy or if you have any problems that need to be treated right away. They are also a time for you to ask questions about any health concerns you have about your child and ask if your HealthCheck services are up to date.

HealthCheck well-child checks take an in-depth look at your child's health.

HealthCheck exams look at all parts of your child's health during regular doctor visits and include:

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

They help to find out if your child:

  • Is meeting growth and developmental milestones.
  • Has ear or eye problems.
  • Has tooth decay.
  • Needs any shots or tests.
  • Has sugar diabetes.
  • Has low blood or sickle cell disease.
  • Has stomach problems.
  • Is experiencing any mental, emotional, or substance abuse problems.
  • Has any 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

 

Are you between 18 and 20 years old?
All HealthCheck information applies to your health care, too.


Are you a grandparent, foster parent, or guardian?
We know that children live in all types of families. The information on this page applies to non-traditional as well as traditional families.

HealthCheck exams and services are covered by your ForwardHealth card

There is no additional cost for a HealthCheck exam. However, if your appointment includes more than HealthCheck, then you may need to pay a deductible or co-pay. You can check with your provider or call Member Services at 800-362-3002, for the most up-to-date information on what services are covered and if there are any limits on the services you need.

Extra visits and care are covered, too

If follow-up visits or special appointments are needed, HealthCheck covers that, too. If you, your doctor, your dentist, or any other professional (like a physician, health official, or educator) who comes into contact with your child or teen has a concern about their health or development, you can go to follow-up appointments. You don’t have to wait for the next scheduled well-child visit.

HealthCheck "Other Services" allows access to services not usually covered

Many Medicaid service limits placed on adults don’t apply to young people.

If your child up to age 20 needs a service not usually covered, a benefit called HealthCheck “Other Services” may cover the costs. Many types of services and products are available through HealthCheck “Other Services.” If it can be covered according to federal Medicaid law and ForwardHealth determines it is medically necessary, it can be covered. HealthCheck "Other Services" may cover things such as prescriptions, physician services, dental care, therapies, home health services, and medical equipment and supplies.

When your child needs a specialized service or product, your doctor will fill out a prescription for it.

Below are the steps to getting HealthCheck “Other Services”

  1. The best way to access HealthCheck “Other Services” is by scheduling a HealthCheck well-child check with your doctor.
  2. If your doctor finds a condition or illness during a well-child exam, they can write a prescription for the service or product your child needs. Your doctor can also help you find a provider for that service or product.
  3. This provider will send the prescription to ForwardHealth with information that explains what your child needs and why. This information is called a prior authorization request.
  4. ForwardHealth will look at all the information submitted and decide if the service or product is medically necessary for your child at this time.
  5. If ForwardHealth agrees that your child needs the service to prevent, correct, improve, or maintain their condition, ForwardHealth will approve the request to cover the service.
  6. ForwardHealth will notify the provider who submitted the prior authorization request of the final decision, and the provider will contact you.

What to do if the prior authorization request is denied or modified

If the request for HealthCheck “Other Services” was denied or approved with a modification, such as a reduction or alteration to the original request, you can contact the provider who submitted the prior authorization request. They should be able to explain why it was denied or reduced.

When a prior authorization request is denied or modified, you have the right to appeal the decision. If you would like to file an appeal, follow the directions included in the letter you received informing you of your fair hearing rights.

More resources

Resources for providers and county waiver agencies

 

The information provided on this webpage is published in accordance with Wis. Admin. Code § DHS 107.22 ESPDT services.

Last Revised: December 17, 2019