Health Check (Medicaid) is North Carolina's Medicaid program for children. NC
Health Choice is health insurance for children of working families who don't qualify for Health
Check (Medicaid) but who may not be able to afford private insurance. The programs are funded by a combination of federal,
state and county governments.
Health Check covers complete medical and dental check-ups, and provides vision and hearing screenings and referrals
for treatment.
Early Periodic Screening, Diagnostic and Treatment (EPSDT) is the federal law that requires Medicaid to provide
medically necessary health care services to Medicaid-eligible children through the age of 20 even if the servcies are not
normally covered by Medicaid or the services are normally only covered for recipients 21 years of age and older.
Why are Health Check and EPSDT Important?
Health Check and EPSDT are important because they:
- provide early and regular medical and dental screenings for all Medicaid eligible-children
- identify treatments that are medically necessary to correct or ameliorate a defect, physical or mental illness or a condition
that is identified through a screening examination.
What Treament Services are Covered?
Services must be ordered by the child's physician or another licensed clinician. Prior approval from the Division
of Medical Assistance may be required to verify medical necessity for some services.
The services must meet all of the conditions stated below:
- The service must be medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that
is identified through a screening examination
- The service must be listed in section 1905(a) of the Social Security Act.
- The service cannot be experimental/investigational, unsafe or considered ineffective.
