Medicaid for Children

Get the Most from Your Benefits

It’s important to know what your benefits are. It’s also important to know how to get the most from the benefits you have. When you have a question about your Medicaid benefits through Highmark Health Options, look in the latest Member Handbook. Still have questions? Call Member Services at 1-844-325-6251, Monday–Friday, 8 a.m.–8 p.m.

Covered Services

Vision Services
expand_more

Vision coverage for children is provided by the State in the Delaware Healthy Children Program. Call Customer Relations, Delaware Division of Social Services, at 1-800-372-2022, or visit the website for more information. Covered services include annual eye exam, glasses, or contacts. Sick eye visits are covered under Highmark Health Options medical benefit.

What is EPSDT?

The federal government requires Highmark Health Options to offer a preventive health program to people age 20 and younger who get Medicaid. It’s called the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. Its purpose is to catch health problems early so children can stay healthy. Highmark Health Options provides the EPSDT program free of charge.

EPSDT wellness visits are also called well-baby and well-child visits. It is important to go to all EPSDT wellness visits. They provide a range of wellness care. They also give parents or guardians the chance to learn more about diet, safety, ways to meet the child’s needs, and the child’s mental well-being. And the visits can sometimes be used as the exam a child needs to get into Head Start or school, or to get a driver’s license.

At wellness visits, the child’s PCP provides screenings and immunizations. The Centers for Disease Control recommends this child and adolescent immunization schedule. The PCP also asks questions, perform tests, and checks how much the child has grown. Depending on the child’s age and needs, the PCP may provide these services:At wellness visits, the child’s PCP provides screenings and immunizations. The Centers for Disease Control recommends this child and adolescent immunization schedule. The PCP also asks questions, perform tests, and checks how much the child has grown. Depending on the child’s age and needs, the PCP may provide these services:

   •   Complete physical exam
   •   Immunizations (vaccinations)
   •   Autism screening
   •   Blood lead level screening test
   •   Developmental screening
   •   Depression screening (starting at age 12)
   •   Hearing test
   •   Vision test
   •   Nutrition evaluation
   •   Oral health exam (mouth)

During the oral health exam, the PCP will decide if the child is due for a dental appointment. The PCP will refer the child for a dental screening when the first tooth shows, or no later than 12 months of age. If the PCP finds the child has a medical condition that requires treatment or equipment, the PCP will call Highmark Health Options to ask for the service or equipment.

Lead Screening

Testing Mandate

The Delaware Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program now requires that all children with Medical Assistance receive a minimum of two (2) blood lead screenings regardless of the child’s risk factors. The tests should be conducted at the 12 month screening and again at the 24 month screening.

The good news is these screening tests will not cost our members anything! You can schedule an appointment with your child’s pediatrician to have his or her blood levels checked. If you don’t have a pediatrician, you can find one near you in the Provider Directory.

Why Get Your Child Tested?

Lead is a naturally occurring metal that can cause serious health problems. Potential lead sources include paint (especially in older homes), toys, soil, dust, and plumbing. Lead is also toxic to everyone, but young children are at greatest risk for health problems from lead poisoning. Blood lead testing can find lead exposure early and prevent long-term damage.

Lead Screening FAQs

What is lead?
expand_more

Lead is a toxic metal used in a variety of products and materials found in your home, including: Paint and/or dust in older homes, soil that contains traces of lead, water that runs through lead pipes, some toys and jewelry, some makeup products, and certain jobs and hobbies can involve working with lead-based products and may cause parents to bring lead into the home.

Who can I call with questions?

We always encourage honest conversations with your child’s doctor regarding your concerns.

If you have questions regarding coordinating your child’s care, scheduling appointments, help with transportation problems, or questions about your child’s lead test or other wellness visits, please contact the Highmark Health Options Care Coordination Team in the Special Needs Unit for assistance at 1-844-325-6251 (TTD/TTY# 711 or 1-800-232-5460 for hearing impaired).