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 HealthCheck
Program Summaries: Eligible Participants and
Providers
Descriptive
HealthCheck Program Summaries
The following
pages contain summaries describing important administrative aspects
of the HealthCheck Program including:
- Eligible
Participants and Providers
- Recipient
Support Services
- Program
Coordination and Outreach
More detailed
information on these topics is available in Sections 1 and 2 of
the downloadable HealthCheck
Manual.
 Participants
and Providers
Eligible
Children and Teens
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HealthCheck
Program services are provided to children and adolescents
under age 21 who are eligible for Medicaid, including:
- Temporary
Assistance for Needy Families (TANF) children
- Newborns
born to women eligible for and receiving medical assistance
- Foster
children
- DC
Healthy Families Program (DCHFP) children
- Children
and adolescents eligible for Supplemental Security Income
(SSI) and SSI-Related Plan (CASSIP)
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Eligible Providers
All DC Medicaid Managed Care primary care providers (PCPs) are responsible
for providing HealthCheck screening services to patients up to age
21.
PCPs in the
HealthCheck Program are defined as:
- Pediatricians
- Family
practitioners
- General
practitioners
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- Internists
- Nurse
practitioners
- Gynecologists
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States
cannot limit EPSDT providers to only those who can provide all mandated
diagnostic and treatment services.
Choosing
Providers
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Families
enrolled in a Managed Care Organization (MCO)1 are
required to choose a provider or one will be chosen for
them.
Enrollees
should choose a PCP who will provide their medical care
and will coordinate the delivery of care from other providers
when necessary.
Many enrollees may continue to see the PCP they have being seeing under another
health program. The PCP provides consistent health care and a medical
home for the child under the HealthCheck Program. |
Mental
Health Services Responsibilities
The following
describes responsibilities for mental health services within the
HealthCheck Program:
- CASSIP MCOs
- Providing and arranging for behavioral health and substance
abuse services
- DCHFP MCOs
- Referring beneficiaries
for behavioral and mental health services
- Addiction,
Prevention and Recovery Administration - Selecting providers for
treatment of alcohol and drug abuse
1
An MCO is a prepaid, capitated plan.
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