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 eligible for Medicaid under the age of 21 years. 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 birth, 3-5 days of age and at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months of age. 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, in addition to other care to treat physical, mental or other problems or conditions found by an exam. Healthchek covers tests and treatment services that may not be covered for people over age 20; some of the tests and treatment services may require prior authorization.
Healthchek services are available at no cost to members and include:
- Preventive check-ups 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, specialist, dentist, optometrist, and other 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 check-ups 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 Paramount Advantage.
Also, for some EPSDT items or services, your provider may request prior authorization for Paramount Advantage to cover things that have limits or are not covered for members over age 20.
As a part of Healthchek, care management services are available to all members under the age of 21 years who have special healthcare needs.
If you would like more information on the Healthchek program, please contact the Member Services Department at 1-800-462-3589, TTY users 1-888-740-5670. Member Services can also help you with and answer questions about getting care and what services are covered, finding a provider/ making an appointment, prior authorizations, or transportation assistance.
You can call your PCP and dentist to make an appointment for regular check-ups and ask for a Healthchek exam when you call.