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HealthCheck Program Summaries: Coordination
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Federal
legislation requires state EPSDT programs to coordinate
with child health related programs to maximize access to
services, prevent duplication, and ensure health care for
children. These programs include:
Coordination
can play an important role in assisting with outreach activities. For
example: |
Healthy Start
Project
HealthCheck
coordinates with the Healthy
Start Project to ensure that members receive counseling, transportation,
scheduling, and other necessary support services as a part of comprehensive
health care.
WIC and Commodity
Supplemental Food Programs
Providers are
required to refer Medicaid families found to be at nutritional
risk
to the WIC Program and the Commodity Supplemental Food Program
(CSFP) (For a list of CSFP sites and referral form, see HealthCheck
Manual Appendices).
For assistance in making referrals or requesting copies of referral
forms, call (202) 645-5663. (For a list of WIC sites and a
copy
of the referral forms, see HealthCheck
Manual Appendices).
DC Healthy
Families
The State Children’s
Health Insurance Program (SCHIP) (called DC
Healthy Families) expands Medicaid eligibility to families and
children with incomes up to 200% of the federal poverty level. DC
Healthy Families has an active outreach and enrollment program.
For further information about enrolling in DC Healthy Families,
contact (202) 526-6266.
Outreach
The
Role of the Medical Assistance Administration (MAA)
MAA identifies
eligible children and families in order to:
- Encourage
their participation in Medicaid/HealthCheck
- Inform them
of the availability and benefits of preventive services
- Provide assistance
with scheduling appointments and transportation
- Help families
use health resources effectively and efficiently
- Monitor and
evaluate the quality of services provided to beneficiaries
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The
Role of the Income Maintenance Administration (IMA)
The Commission
on Social Service/IMA provides information to the Medicaid
applicants about HealthCheck screening services during
the initial Medicaid eligibility interview and through
the subsequent recertification process.
Each
applicant/recipient should receive a “Get Healthy,
Stay Healthy” HealthCheck flyer (English and Spanish)
(See HealthCheck
Manual Appendices). |
The
Role of Managed Care Organizations (MCOs)
MCOs should distribute HealthCheck information to members who select
or who are assigned to the MCO.
MCOs shall conduct
outreach activities to assist HealthCheck-eligible enrollees keep
well-child appointments, including:
- Appointment
reminders (phone
or mail)
- Personal
home visit, where feasible, if there is still no response
- Direct contact
with adolescents, when appropriate
MCOs are also
expected to coordinate their enrollees’ health care with the
following child health related groups:
- DC Public
Schools (DCPS), Department of Special Education
- Department
of Human Services (DHS), DC Early Intervention Program
- DHS, Administration
for Child and Family Services
- Head Start
- Department
of Mental Health
- Maternal
and Family Health Services
- Others as
appropriate
The
Role of the Provider
All Medicaid
service providers are required to give written and oral EPSDT
notice to eligible children and families.
At the first visit
- Give written materials describing EPSDT services
in simple terms to all eligible recipients including:
- pregnant women
- parents
- child custodians
- teens
- all individuals
who are blind or deaf, or who are illiterate
At subsequent visits
- Continue
to provide eligible children and families with written materials
describing EPSDT services in simple
terms
(unless the provider
has
given
such material within the preceding
year)
Annually
- Provide an oral explanation of the EPSDT
program
to all eligible recipients who use Medicaid services during
the year
This concludes
the Overview section.
The next page contains Review Questions for the information
presented in this module.
Move on to the next section, Health
Supervision, after completing the review questions. |
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