Medicaid HealthCheck “Other Services”
What is HealthCheck “Other Services”?
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, treatments or supplies not typically covered under Wisconsin’s Medicaid Plan.
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.
Examples of Services or Supplies that Can be Covered by HCOS
If your child’s doctor has recommended over-the-counter medications these may be paid for through HCOS. This benefit may also cover certain mental health and dental supports and services, special equipment and supplies that are not covered under the state’s Medicaid Plan.
- Electrolyte solutions
- Iron supplements
- Topical protectants (like Calamine)
- Vitamin D drop
A list of all products that don’t need a PA to be covered by HCOS is available at bit.ly/2G6CgGa. Over-the-counter products that are not on this list will need a PA. Remember, all over-the-counter products need to have a prescription.
Mental Health Services
- Child and adolescent mental health day treatment
- Intensive in-home psychotherapy
- Comprehensive behavioral treatment
- Dental Services
- Orthodontia (braces)
- Other dental services
How Can HCOS Pay for a Service or Supply?
Like other Medicaid services, for this benefit to cover a medical service, treatment or supply, your child’s health care provider must show that it is medically necessary. To do this the provider needs to document it in the medical record and give you a prescription for the service or support.
The service or supply can be identified during your child’s annual exam, which is a full, well-child physical exam. It can also be identified during a clinic visit. The provider may also need to submit a Prior Authorization (PA) request.
Tip for Families
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 persistent!
Need help? Contact one of these groups:
- Regional Centers for Children and Youth with Special Health Care Needs at dhs.wisconsin.gov/cyshcn/regionalcenters.htm
- ABC for Health, a public interest law firm, at 800.585.4222 or safetyweb.org.
Steps to Using the HealthCheck “Other Services” Medicaid Benefit
Step 1: Make an appointment for an annual physical exam with Medicaid enrolled providers.
- Appointment needs to be a complete physical exam, annual physical or a well-child exam.
Step 2: During this appointment or another clinic visit 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.
- Call the ForwardHealth hotline at 800.362.3002.
Step 3: Get a prescription for any needed services or supplies,
- Use a pharmacy that accepts Wisconsin Medicaid.
- Ask if Medical provider will need to submit a Prior Authorization (PA).
- Discuss why item is medically necessary for your child.
- If your provider is unfamiliar with PA process: ForwardHealth Update on PA process for providers forwardhealth.wi.gov/kw/pdf/2019-08.pdf.
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.
Tip for Families
Use a pharmacy where you’re a regular customer. Knowing the pharmacist can make this process easier.
If your child’s providers or your pharmacist is unfamiliar with this Medicaid benefit have them contact ForwardHealth Provider Services at 800.947.9627.
Need help finding providers? Contact your Regional Center for Children and Youth with Special Health Care Needs at dhs.wisconsin.gov/cyshcn/regionalcenters.htm or call Well Badger Resource Center at 800.642.7837.