HealthCheck Fact Sheet
One of the most valuable tools we have to ensure that West Virginia children stay healthy is HealthCheck. The mission of HealthCheck is to ensure that Medicaid-eligible children receive preventive health care at regularly established intervals and that identified health problems are diagnosed and treated as early as possible.
The legal foundation for HealthCheck is section 1905(r) of the Social Security Act, which defines the term "early and periodic screening, diagnosis and treatment services" (EPSDT). The EPSDT Program was expanded in the Omnibus Budget Reconciliation Act of 1989 to allow additional services. EPSDT is a requirement of every state Medicaid plan; essentially it's Medicaid's pediatric preventive care health benefit. Every child with a WV Medicaid card is eligible to receive services under EPSDT.
The EPSDT acronym means:
- Early - A Medicaid-eligible child should begin to receive high quality preventive health care as early as possible in life.
- Periodic - Preventive health care should occur at regular intervals according to an established schedule that meets reasonable standards of medical, vision, hearing, and dental practice.
- Screening - Screening services include all the following:
- A comprehensive health and developmental history;
- Immunizations recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP);
- Laboratory tests and lead toxicity screening;
- Health education including anticipatory guidance;
- Vision and hearing services to include diagnosis and treatment defects;
- Dental services to include relief of pain and infections, restoration of teeth, and maintenance of dental health;
- Unclothed head-to-toe physical examination to identify those who may need further diagnosis, evaluation, and/or treatment of their physical and mental problems; and
- Other necessary health care as described in section 1905(a) of the social Security Act to correct or ameliorate defects, and physical and mental illnesses and conditions discovered by the screening services.
- Diagnosis - The determination of the nature or cause of physical or mental disease, conditions, or abnormalities identified during a screening.
- Treatment - Health care or other measures provided to correct or ameliorate defects, physical and mental illnesses, or chronic conditions identified during a screening.
Outreach and education are important elements of the EPSDT benefit. The parents and guardians of Medicaid-eligible children must be effectively informed of the availability of EPSDT services, the importance of immunizations, and the benefits of preventive health care. In addition, prior to the due date of a child's initial or periodic screening, transportation assistance and appointment scheduling must be offered and if needed, provided.
HealthCheck employs nine (9) community-based Regional Program Specialists to equip West Virginia's Medicaid providers with the necessary tools and knowledge to carry out EPSDT services appropriate to the American Academy of Pediatrics' standard for pediatric preventive health care, Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, and to provide ongoing technical assistance regarding the requirements and expectations of the EPSDT benefit.
HealthCheck supports the medical home approach to providing comprehensive primary care and believes the success of Bright Futures health supervision depends on continuing partnerships between the individual patients/families and their personal physicians in medical home settings.