Early and Periodic Screening Diagnosis and Treatment (EPSDT)
Healthchek is Ohio’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Healthchek covers medical exams, immunizations (shots), health education and laboratory tests for everyone on Medicaid from birth to 21st birthday. These exams are important to make sure that children are healthy and are developing physically and mentally. Mothers should have prenatal exams and children should have exams at the following ages:
After that, children should have at least one exam per year.
Healthchek also covers complete medical, vision, dental, hearing, nutritional, developmental and mental health exams. It includes care to treat physical, mental or other problems or conditions found by an exam. Some of the tests and treatment services may require preapproval.
Healthchek services are available at no cost to members and include:
- Preventive checkups for newborns, infants, children, teens and young adults under the age of 21.
- Healthchek screenings:
- Complete medical exams (with a review of physical and mental health development)
- Vision exams
- Dental exams
- Hearing exams
- Nutrition checks
- Developmental exams
- Lead testing
- Laboratory tests for certain ages
- Medically necessary follow-up care to treat physical, mental or other health problems or issues found during a screening. This could include, but is not limited to, services such as:
- Visits with a primary care provider (PCP), specialist, dentist, optometrist and other CareSource providers to diagnose and treat problems or issues
- Inpatient or outpatient hospital care
- Clinic visits
- Prescription drugs
- Laboratory tests
- Health education
It is very important to get preventive checkups and screenings so your providers can find any health problems early and treat them, or make a referral to a specialist for treatment, before the problem gets more serious. Some services may require a referral from your PCP or prior authorization by CareSource. Also, for some EPSDT items or services, your provider may request prior authorization for CareSource to cover things that have limits or are not a covered benefit.
As a part of Healthchek, care management services are available to all members with special health care needs, from birth to one’s 21st birthday. If you would like more information on the Healthchek program, please call Member Services.
Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), 7 a.m. – 7 p.m., Monday – Friday