Help! I have a little boy who is four years old. I am afraid that he may have some medical problems that he needs help with. I don’t have medical insurance to cover him but I’m told that he may be eligible for medical assistance through Medicaid. How can I get him the medical coverage he needs?

Your son may be able to receive the medical coverage he needs through the Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) program. In Washington, the EPSDT program is called "Healthy Kids".

What is the "Healthy Kids" program?

Healthy Kids is a comprehensive and preventative child health screening and treatment program to detect and treat physical and mental problems.

When a child is enrolled in the Healthy Kids program he or she is entitled to receive a medical, dental, vision, and hearing screening.

Is this screening a "one time only" examination?

No. Remember EPSDT stands for Early and Periodic Screening, Diagnosis and Testing. There is a schedule for when children receive a Healthy Kids screen that depends on the child’s age. For example, a one year-old child is entitled to a screening up to five times their first year. A four year old is entitled to a screen once a year. Additionally, a child can have a screen at any time, if a problem is suspected, whenever medically necessary to detect a problem.

Is Healthy Kids a state program?

EPSDT is a federal Medicaid program. "Healthy Kids" is the Washington state program that implements EPSDT.

How do I find out if my son is eligible?

Healthy Kids is available to all children who are eligible for medical assistance, children who have DSHS medical coupons, and children who are on Supplemental Security Income (SSI). To enroll your child in the Healthy Kids program you need to contact your local Community Support Office (DSHS or welfare office). You can apply in person at the Community Support Office or apply over the telephone by calling 1-800-204-6429. You can also receive and return an enrollment application through the mail.

Do I have to take my son to a "Healthy Kids Specialist" or do I have a choice?

There are no special "Healthy Kids" providers - providers just need to accept medical assistance medical cards and have a Medicaid number.

Do I have to take my son to one provider for the screening and yet another doctor for treatment?

No. The same provider can do both the Healthy Kids screening and provide treatment. Both can even be done in the same appointment if needed.

Some providers may not be aware of this, however. Providers can get reimbursed from Medicaid for providing the screening and the treatment, even if it is all done within one office visit.

I do not own a car so sometimes I may have a hard time getting my son to the doctor. Can I get help with this also?

Yes. Once again you should call your local Community Support Office for assistance. DSHS will pay for transportation to medical appointments through a broker if no other arrangements can be made. DSHS will also provide interpreters for families when needed.

This is very helpful. I’ll contact my local Community Support Office right away. Where else can I get information about EPSDT?