Members under age 21 are eligible for a special program called the Growing Up Program. This program includes all of the services recommended by the West Virginia Bureau for Medical Service’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. The purpose of the program is to find children’s health problems early and to keep checking to be sure those children stay healthy.
Your child's PCP will check on many areas of health during EPSDT exams and screenings. The doctor will check on your child's heart, lungs, eyesight, hearing and teeth. If you child's doctor finds areas of concern, your child's doctor will make a referral for other tests or to a specialist as needed. The doctor may refer children age 3 and above to a dental home as part of their regular EPSDT well child screens.
For the EPSDT visit, the doctor could also give your child shots, or ask about the child's nutrition or diet. The doctor will also check other areas that are important to your child by testing the child's urine or blood for anemia and lead levels. The doctor will also ask questions about your child's mental health, speech, social actions and behavior – the way your child relates to other kids their age. Finally, the doctor will ask questions to put together a family medical history.
During your child's EPSDT exam the PCP will identify if your child is due for a dental referral based on his / her age. The PCP will advise you if the child is need of a referral. The PCP will also notify us of the need for a dental referral as part of the program. We have staff that will contact you and offer assistance in setting up dental appointments if needed. Please remember dental health is very important even with very young children. Talk to your PCP about your child's dental health at each EPSDT visit.
It is very important that you keep your EPSDT appointments with the doctor. These physical exams can sometimes be used as the exam your child needs to get into Head Start, or for school, or for a driver's license physical.
Your child's doctor may find that your child needs a medically necessary service or a piece of equipment to treat a problem found during a screening visit. If so, your child's doctor can call West Virginia Family Health Plan (WVFH) to ask for the service or equipment, and it will be reviewed for approval.
If you need more information about the Growing Up program, please call Member Services at 1-855-412-8001. The staff can also help you set up an appointment for your child, assist you with dental appointments or help you get a ride for these appointments.
Minors are treated as adults when it comes to birth control, pregnancy or family planning (except for sexual sterilization). Our members who are 13 years of age or older may refer themselves to any network or out-of-network OB/GYN for yearly exams and regular health care services (including cervical cancer screenings). They do not need an approval ahead of time from their PCP.
Family planning records are kept private. Doctors should keep all family planning records private, even if the patient is a minor, unless the law says it is OK to share your information with others. Your doctor is allowed to share your medical information with other doctors who take care of you, public health officials, or government agencies. We are not responsible for the privacy of medical records held by providers who are not part of your health plan network.
These visits are free for enrolled members under 21 years of age.
These include screenings needed for your child's PCP to understand any medical needs. During these visits the PCP will complete a physical exam and a complete health and developmental history. Vaccines (shots) are part of these visits.
Ask your child's PCP when you should bring your child back for the next EPSDT checkup.
What is a covered service?
- Dental exams
- Nutritional needs
- Health care, treatment and other actions to correct or improve any medical condition found during an EPSDT screening
- Routine shots and immunizations
- Lab tests, such as:
- Tuberculin test (for high-risk groups)
- Blood lead testing
Well Child Check Up Schedule
Learn more about what to expect at a Well Child Visit.
Download the West Virginia Health Check Program Periodicity Schedule (PDF)
Download and view
Download the Bright Futures Periodicity Schedule
Download and view
Learn more at www.dhhr.wv.gov
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