Benefits for Children

Help your child get the care they need.

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.

Take your child to all routine wellness visits.

Wellness visits with your child’s doctor start when your child is an infant. And they happen at 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 24 months, 30 months, and every year until age 20.

Any child enrolled in coverage from Highmark Health Options is part of Building Healthy Futures, a no cost Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. Here’s what this means.

  • E is for Early: Find problems early when they are easier to treat.
  • P is for Periodic: Check your child’s health at different ages and time periods.
  • S is for Screening: Use screening tests to check for physical, mental, dental, and other possible problems. Screenings and services are free.
  • D is for Diagnostic: Follow up with tests or a specialist to learn more about a problem.
  • T is for Treatment: Treat your child’s health problem. Your child’s doctor will talk to you about what happens next.

The EPSDT team at Highmark Health Options is here to remind you when your child is scheduled for wellness visits or needs preventive care. You may hear from a member of our team if your child misses a visit or screening. At any time, you can call Member Services at 1-844-325-6251 and ask for a member of the EPSDT team to help you with your child’s care. We can help you make an appointment, find a specialist, arrange transportation, and connect with helpful community resources.

More about lead poisoning and screening.

What is lead?

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.
Required screening

The EPSDT program now requires that all children with Medical Assistance receive a minimum of two 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.

Here for you.

Call Us
  • If you’re not sure where to go for your child's health care or have questions about a health concern, call the 24-Hour Nurse Line at 1-844-325-6251.
  • If you have questions about your child's benefits, call Member Services at 1-844-325-6251, Monday–Friday, 8 a.m.–8 p.m.
  • TTY callers should dial 711 or 1-800-232-5460.