This is a brief webcast about public healthcare for children and youth up to age 21. Know about kids' rights to get all the medical and mental health care that they need!
This webcast was produced by the Northwest Justice Project nwjustice.org and TeamChild TeamChild.org.
In Washington State, kids can apply for healthcare benefits with a parent or guardian at a local community service office of the Department of Social and Health Services. You can find your local community service office online:
To grow up healthy and strong, kids should regularly go to the doctor. Regular check-ups and visits to a doctor when a child is sick or needs a specific kind of treatment are guaranteed for kids who have public medical assistance (like Medicaid).
Whose healthcare rights are we talking about?
1. Children and youth, age 20 and younger
2. who receive Medicaid or another state medical benefit like Apple Health for Kids or the Children's Health Insurance Program. (Kids who have a "medical coupon" or a Provider One card probably have Medicaid or other medical assistance.)
What healthcare can youth get? Children and youth who have public medical assistance have the right to get all "medically necessary" healthcare treatment. This means regular check-ups and health screenings. It also means any treatment that is recommended by a doctor or other medical professional (like a therapist) to help a kid feel better or prevent a kid from getting or feeling worse.
The legal term for kids' right to get all needed healthcare is "Early and Periodic Screening, Diagnostic, and Treatment Services" or EPSDT. It's a long term that spells out the rights of youth.
"Early" means to get health care before problems get worse. "Periodic" means to regularly go to see doctors. "Screening" means kids can get check-ups. "Diagnostic" means to get an explanation of what is causing a kid to have certain symptoms or feel a certain way. "Treatment" means to get needed help from a doctor or another kind of health care provider like a counselor.
Kids can get regular check-ups even when they are feeling well. Babies under two can get check-ups several times during the year. Kids through age 20 can get check-ups every year to two years.
Here are examples of other kinds of healthcare a kid can get:
- Visits to a doctor and treatment when they are feeling sick
- Vision screening to find out if they need glasses
- Dental care to keep teeth strong and healthy
- Mental healthcare, including counseling, medication and many other services
- Treatment to help a kid stop using drugs or alcohol
If you already have a doctor, you can ask to schedule a check-up (sometimes called a "well-child exam") or an appointment if you have a specific need. If you don't already have a doctor, and you are in a Healthy Options managed care plan, contact that plan. Or you can call the Medical Assistance Customer Service Center to get more information and ask about doctors near you. Not all doctors accept all medical assistance benefits and some are not taking new patients at this time, so you may have to call more than one.
If you need mental health care or substance abuse treatment, you can ask your doctor for a referral. Or you can go directly to local community programs in your area that accept Medicaid or other public medical assistance.
Sometimes kids have trouble getting the healthcare treatment that they need, even though they have the right to get all the help that they need. If your healthcare services are changed, reduced, denied, or stopped, you have the right to challenge the decision by asking for a fair hearing. You may have a very short time to request a fair hearing. To protect your rights, you should ask for a fair hearing right away. Click here to watch a video and learn more about how to ask for a Fair Hearing in Washington: youtu.be/67b47nsceUw
We hope this video included helpful information about children's right to healthcare.
The main point is that if you are under 21 and receive public medical assistance (like Medicaid), you can get all the regular and preventative physical and mental health care that you need.
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This video was produced in June 2012; the laws may have changed since that time. This video provides general information only. Your situation may be very different than those shown in this video. This video is not a substitute for talking to a lawyer about your unique situation. It does not create an attorney-client relationship and it cannot predict or guarantee an outcome in any legal proceeding.