HealthCheck “Other Services” (HCOS) is a Medicaid benefit for children under age 21 who are enrolled in Medicaid programs like Katie Beckett, SSI, Waiver MA, or BadgerCare Plus. HCOS may cover medically necessary services, treatment or medical supplies not typically covered under Wisconsin’s Medicaid Plan. If your child is covered by Medicaid, they are eligible for this benefit of the Medicaid program.

HealthCheck is Wisconsin’s name for Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a federal Medicaid benefit. HCOS is the treatment part of this benefit.

This Medicaid benefit includes services such as:

• • • Dental care
    • Home health services
    • Medical equipment and supplies
    • Medicines
    • Physician services
    • Therapies

All services must be:

• Able to be covered according to federal Medicaid law, and
• Verified as medically necessary by ForwardHealth.

Examples of Over-the-Counter Supplies that HCOS Can Cover

(Find the complete list in the Frequently Asked Questions resource go to “Can Medicaid Cover Some of My Child’s over-the-counter medicines?”)

Also see:

HealthCheck Other Services for Over-the-Counter Coverage – Provider Flyer

 HealthCheck Other Services for Over-the-Counter Coverage – Member Flyer

• • • Antidiarrheals
    • Calcium
    • Electrolyte solutions
    • Iron supplements
    • Laxatives
    • Multivitamins
    • Melatonin
    • Simethicone
    • Topical protectants (like Calamine)
    • Vitamin D drop

Examples of Mental Health Services and Dental Health Services Covered by HCOS

• • • Child and adolescent mental health day treatment
    • Intensive in-home psychotherapy
    • Comprehensive behavioral treatment
    • Dental Services
    • Orthodontia (braces)

How Can HCOS Pay for a Service or Supply?

For Medicaid to cover a medical service, treatment or supply, your child’s health care provider must show that it is medically necessary. The provider needs to document this in your child’s medical record and give you a prescription for the supply or service.

The service or supply can be identified during your child’s annual full, well-child physical exam or during a clinic visit. The provider may need to submit a Prior Authorization (PA) request to Medicaid explaining why the item is medically necessary – this is very common.

HCOS is new for many providers and pharmacies. You may hear that it’s more paperwork or that they don’t understand the process. Our advice to families is to be kind but persistent. 

Steps to Using the HealthCheck “Other Services” Medicaid Benefit

Step 1: 

Make an appointment for an annual physical exam for your child. The appointment needs to be a complete physical exam, annual physical or a well-child exam.

Step 2: 

During this appointment, ask about medically-related services or supplies that your child needs.

Not sure if something is covered by your child’s ForwardHealth card or HCOS? 

Talk to the clinic staff, call your pharmacy or call the ForwardHealth hotline at (800) 362-3002.

Step 3: 

Request a prescription for any medically needed services or supplies. If the supply can be purchased at a pharmacy, go to a pharmacy that accepts Wisconsin Medicaid. If your child’s provider recommends other medical, therapy or dental services, ask the clinic to help you receive a referral to a provider who accepts Wisconsin Medicaid.  You may need to remind your child’s medical provider to submit a PA and confirm that medical necessity is documented in your child’s medical records.

Step 4: 

Pick up your over-the-counter supply at a Medicaid enrolled pharmacy. Check out at the pharmacy like you would for other prescription medications. Retail stores will not be able to bill the supply to Medicaid using HCOS.

What if Medicaid Denies Covering the Service or Supply?

As with any medical service or treatment that your provider recommends, if your child’s provider submits a PA and it is returned as denied or changes are made to decrease the services covered, families are encouraged to appeal.  You will receive a letter explaining the denial and it will include instructions on how to submit a formal appeal. To learn more, read Family Voices article Medicaid: Appealing a Denial.  

Need Support to Appeal a Denial or to Use this Medicaid Benefit?

Contact ABC for Health, a public interest law firm, at (800) 585-4222 or safetyweb.org