Children’s Long-Term Support: HealthCheck Information for Counties
HealthCheck is Wisconsin’s name for what the federal government calls the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. It provides health care services for Medicaid members under age 21. The goal of HealthCheck is to provide comprehensive health care services that are coverable under federal rules and are medically necessary to treat, correct, or reduce a member’s illnesses and conditions.
County waiver agencies (CWAs) are an important connection to HealthCheck for families in the Children’s Long-Term Support (CLTS) Program. CWA staff:
- Tell families about HealthCheck and HealthCheck Other Services
- Explain to families how it works
- Help families access it
Use this webpage to understand more about HealthCheck and HealthCheck Other Services. See FAQs about HealthCheck for CWAs for specific details CWA staff can use.
Find key resources
Provider video
Watch the provider video for an overview of HealthCheck.
FAQs
Find more details about information on this page and answers to frequently asked questions for CWAs.
Understand HealthCheck
HealthCheck covers preventive services
HealthCheck visits are called well-child checks. Well-child checks are doctor’s appointments for Medicaid members under 21 where doctors monitor the member’s health and development and prevent or identify problems before they become serious. It’s a good time to ask health questions. HealthCheck well-child checks follow guidelines from the American Academy of Pediatrics’ Preventive Care Schedule. Things that can happen during a well-child check include:
- Dental checks
- Growth and development checks
- Head-to-toe physical exams
- Hearing and vision checks
- Immunizations
- Lab tests
- Nutrition checks
HealthCheck also covers follow-up visits and special appointments if the doctor finds things that should be looked at further. For example:
- Dental concerns
- Ear or eye concerns
- Growth and developmental milestones
- Mental, emotional, or substance use concerns
- Needed tests or vaccines
- Other medical concerns
Follow-up visits or special appointments that are made due to something found during a well-child check are usually covered by HealthCheck.
Anyone with a ForwardHealth card can use HealthCheck
The benefit covers most services and items for people under 21 who have Medicaid coverage. If they have a ForwardHealth card, they have Medicaid. Families use their ForwardHealth card to access HealthCheck services for their child.
Understand HealthCheck Other Services
HealthCheck Other Services fills coverage gaps
Members under 21 can use a benefit called HealthCheck Other Services to get services Medicaid typically doesn’t cover. Federal EPSDT laws require this coverage. Members can use HealthCheck Other Services to get a service or item if it is:
- Prescribed by the member’s provider.
- Able to be covered according to federal Medicaid law.
- Approved by Wisconsin Medicaid, based on information submitted by the member’s health care provider.
Some common services or items members may be able to get through HealthCheck Other Services are:
- Behavioral and mental health treatment
- Durable medical equipment
- Disposable medical supplies
- Orthodontia
- Over-the-counter items
- Personal care services
HealthCheck and HealthCheck Other Services don’t cover some things
There are some services and items HealthCheck and HealthCheck Other Services don’t cover, like:
- Structural or home modifications (such as ramps, stair lifts, fences, permanent fixtures for ceiling lifts)
- Vehicles and vehicle modifications (such as vehicle lifts or carriers)
- Items already purchased by the family or another funding source (Medicaid does not directly reimburse members)
- Experimental services and items
Know key contacts
Provider Services Call Center
They help providers with questions about:
- Billing
- Coverage policy
- HealthCheck enrollment
Provider Relations Representatives
They help professionals:
- Answer more complex questions than Provider Services
- Answer questions about coverage policy
- Find Medicaid providers
Bureau of Children's Services (BCS) Technical Assistance Center
They can explain how the Children’s Long-Term Support Program and Medicaid intersect.
You can also call them at 608-267-6767.
ForwardHealth Member Services
They help families:
- Find providers
- Get new ForwardHealth cards
- Understand Medicaid covered services and copays
You can also email them at memberservices@wisconsin.gov.
Find related resources for members
- ForwardHealth: HealthCheck FAQs for Participants and Members
- HealthCheck: Supporting Your Child’s Health, Brochure, P-01007
- HealthCheck: Supporting Your Child’s Health, Mini Poster, P-01007A (PDF)
- HealthCheck Other Services Over-the-Counter Drug Coverage Member Flyer, P-03630
- Over-the-Counter Drugs Covered by HealthCheck Other Services (PDF)
- Over-the-Counter Drugs Covered by BadgerCare Plus and Medicaid (PDF)