Benefits 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.

Dental Services

Dental 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 oral exams, x-rays, cleanings, fluoride applications, fillings, and other restorative and specialty services. Orthodontic care is also available for children who meet specific program guidelines.

Hearing Services

Hearing 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 hearing exam, fittings for hearing aids, and hearing aids. 

Diagnostic Services and Treatment

When a screening examination indicates the need for further evaluation of a child's health, diagnostic services must be provided. Necessary referrals should be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation. States should develop quality assurance procedures to assure that comprehensive care is provided. Necessary health care services must be made available for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.

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.

What health problems can lead cause?

Exposure to lead can seriously harm a child’s health. Exposure to lead can cause:

  • Damage to the brain and nervous system
  • Slowed growth and development
  • Learning and behavior problems
  • Hearing and speech problems

These health problems can impact children long term. These health problems can cause:

  • Lower IQ
  • Decreased ability to pay attention
  • Poor performance in school

Children under the age of 6 are most at risk because they are growing so rapidly. Younger children tend to put their hands and other objects in their mouth which can be contaminated with lead dust. Lead dust can be invisible to the naked eye.


The good news: Lead poisoning is 100% preventable!

What are the symptoms of lead exposure?

Most children with elevated lead levels have no symptoms.

That is why testing is so important! Talk with your child’s doctor about a simple blood lead test. Testing is the only way to know if your child has elevated blood lead levels. This test may be completed by a simple finger stick blood test. If the finger stick shows that your child has high lead in their blood, then your child will be referred for a blood draw.

When should your child be tested for lead?

Your child should be tested:

  • At 12 months of age and
  • Again at 24 months of age (2 years old)

This test can be completed as part of their regular wellness child visits to your child’s provider at these ages. Testing is the only way to know if your child has been exposed to lead.

What if my child missed their lead test at those visits?

You can still get a lead test done.

Two lead tests should be completed by the age of 2. However, children can be tested even after the age of 2. Children under the age of 6 are at risk.

If a child is not tested at their 2 year visit, the child should be tested as soon as possible after their 2 year visit, but before they turn 6 or enter into Kindergarten, whichever is first.

What exactly is a lead test?

A lead test can be conducted in 2 different ways.

Capillary blood sample testing – A small lancet (needle) is used to puncture the skin. This can be done on the foot or the finger. A small amount of blood will be collected in a tube.

Venous blood sample testing – A needle is used to collect blood into an attached tube from a vein in the arm. This is the most accurate way to measure lead levels in the blood.

My child tested positive, now what?

Resource Coordinators from Highmark Health Options Health will reach out to you to assist with coordinating follow up care after a positive lead test.

Depending on your child’s lead level, your physician may recommend an Environmental Lead Investigation. An Environmental Lead Investigation includes an investigation of your home including all painted surfaces, water samples, dust samples, and bare soil samples.

How can I reduce my child's exposure to lead?
  • Clean windowsills and floors regularly with a damp paper towel and throw the towel away.
  • Make sure your child does not have access to peeling paint or painted chewable surfaces.
  • Have peeling paint removed from your home.
  • Let water run for a few minutes before using or consuming it, especially if you might have lead pipes.
  • Wash your child's hands, face, and toys regularly.
  • Remove your shoes before entering the house to avoid bringing in possible contaminated soil.

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).