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Madison Myers Galloway (copy)

A dental resident checks the teeth of an 11-year-old during an office visit at Riley Hospital for Children’s Department of Pediatric Dentistry in Indianapolis in 2016. 

Prevention programs are a vital part of our public health system, particularly for children. Although strong programs for children exist, red tape, ignorance, and indifference stand in the way of needed services. In Wisconsin, children receiving BadgerCare Plus or Medicaid services need improved access to legally required prevention and medical treatment services. Inadequate outreach and education for parents, providers, and advocates lead to poor child health screening and treatment referral rates in Wisconsin as compared to other states.

Historically, Wisconsin consistently fails to address and serve the health care needs of many vulnerable children. We can and must do better. And we will. That is why we are creating an action plan to help Wisconsin’s children.

HealthCheck is Wisconsin’s name for a federal Medicaid program feature called Early and Periodic Screening, Diagnosis, and Treatment. HealthCheck provides medical, vision, hearing and dental preventative care (screenings, “well-child checks”), treatment, and case management services for Medicaid-eligible children up to age 21. Medically necessary treatments, services, and/or products are covered through “HealthCheck Other Services” even if they would not typically be covered under Wisconsin Medicaid. Examples include certain medications, mental health services, and equipment.

As important as HealthCheck is for children, many Wisconsin health care providers and parents are unaware of the program’s benefits. In fact, a recent survey by a coalition of advocates showed that 80 percent of families and 90 percent of providers were unaware of HealthCheck. In response, ABC for Health Inc., a nonprofit law firm in Madison, partnered with other advocates to address knowledge and program barriers and promote education and outreach for stakeholders including families, providers, and advocates. Our HealthCheck Task Force approached state of Wisconsin staff to stimulate outreach, education, and policy improvement strategies. Such efforts will target HealthCheck stakeholders to assure that children receive all available and necessary HealthCheck services.

Outreach and education are key to promoting HealthCheck. In the past, Wisconsin largely assigned HealthCheck outreach to BadgerCare Plus HMOs and local health, human services, or social services departments. Today, we need a stronger effort to promote HealthCheck; our HealthCheck Task Force is ready to partner with public health organizations, health plans and other interested stakeholders to improve awareness and use of HealthCheck services.

Importantly, the law is on the side of kids and families. Federal Medicaid law requires Wisconsin Medicaid/BadgerCare Plus to screen and cover medically necessary treatments that improve or stabilize health conditions for eligible children and young adults. However, program red tape creates coverage barriers for some services. For example, parents seeking help for children with food aversion associated with autism spectrum disorder and families with children needing mental, emotional, and behavioral health treatments often face coverage and service challenges. Additionally, Wisconsin is well below the national average rate for HealthCheck dental referrals and services; only one-quarter of HealthCheck-eligible children receive dental care each year. According to federal law, it is mandatory that Medicaid-eligible children obtain a referral to a named dentist for dental screens.

The HealthCheck Task Force is developing accessible education, outreach, and social media strategies to help ensure that all children obtain quality health services required by law and to increase momentum toward this goal — but we still need help!

What can you do?

• Learn more about HealthCheck at www.healthwatchwisconsin.org.

• Help medical providers recognize HealthCheck services for children.

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• Spread the word about HealthCheck!

Recently, Gov. Tony Evers added the leverage of his administration in the form of executive orders that direct the Department of Health Services to take steps toward expanding access to health coverage. These include increasing health care coverage; improving health care access; investing in prevention and wellness; reducing health disparities; and more. We know an improved HealthCheck process can help achieve these important objectives.

For now, however, HealthCheck fails to meet the promise of better health for thousands of children, especially those impacted by health disparities. In order for Wisconsin to build a stronger HealthCheck program, we must change policies and promote a culture of equitable education and assistance that connects our most vulnerable children to vital health care services. Wisconsin must step forward to ensure the legal and efficient application of the HealthCheck program’s policies that provide our children with the health care services they need and deserve.

Robert A. Peterson Jr., JD, and Kali A. Kramolis, MD/MPH candidate, are with the Madison-based ABC for Health Inc.

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