If your child is covered by Medicaid, you might want to know more about HealthCheck “Other Services” (HCOS). This is a benefit for children that covers items not typically covered by the ForwardHealth card. If you haven’t used it, you’re not alone! In Wisconsin, HCOS has been underused and often difficult to access. The Department of Health Services has recently undertaken new efforts to clarify and  streamline Medicaid so that providers and families can take advantage of this benefit. This is due, in part, to the strong advocacy efforts of Family Voices, ABC for Health and others.

What is HealthCheck and HealthCheck “Other Services”? 

HealthCheck is part of the federal Medicaid benefit  for children known as Early and Periodic Screening, Diagnosis and Treatment or EPSDT. It is intended to improve the health of all Medicaid eligible children, including those with special physical, emotional, and developmental health care needs. In Wisconsin, EPSDT is known as HealthCheck.

An annual exam, or well-child visit, is a physical exam that can help identify health conditions or medical needs. If treatment or services are recommended, but not typically covered under Wisconsin Medicaid, HCOS can cover these services. In this case, your child’s provider must document that the service  needed is medically necessary and may need to complete a prior authorization (PA) request. 

HCOS is NOT a new program. If children are enrolled in Medicaid programs they can use it to cover needed services and supplies. There isn’t any additional signup or registration needed and there isn’t any extra cost.

Examples of HCOS Covered Services 

• Child and adolescent mental health day treatment,
• Intensive in-home psychotherapy,
• Comprehensive behavioral treatment,
• Orthodontia (braces) and other dental services not typically covered,
• Certain over-the-counter medications like multivitamins, Vitamin D, laxatives, iron supplements or pediatric electrolyte solution,
• Special equipment like a car seat for an older child,
• Shoes to fit over braces and some types of orthotics.

The treatment, service or supply must be identified during the child’s annual exam or other clinic visit, and a prescription must be written by a Medicaid-enrolled provider. The provider may need to complete a PA request.

Who is Eligible for this Benefit?

HCOS can be used to cover services, treatment and supplies for any child, under age 21, enrolled in Medicaid programs like Katie Beckett, SSI, Waiver Medicaid, or BadgerCare Plus.

HCOS provides payment for additional health services that are found to be medically necessary. Medical necessity is determined on a case-by-case basis, based on each child’s needs. The service or supply must meet Wisconsin’s definition of medical necessity, which is found at Wis. Admin. Code § 101.03(96m).

Our Family Voices Fact Sheet, Medicaid HealthCheck Other Services, has more detail and a step-by-step guide on accessing these services. Resources to get help and ways to educate your provider are included.

Why the Mystery? A 2018 survey by the Survival Coalition found that 80% of families and 90% of providers had no knowledge of HCOS.