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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

Guidelines for Well-child Care

Date: 09/12/19

California Health & Wellness Plan (CHWP) urges providers to discuss yearly well-child care with parents. To keep children healthy and develop normally, each year, children should have the following:

  • Well-child visits.
  • Routine health screenings.
  • Needed immunizations.

For children under age 21 who are enrolled in Medi-Cal, services are provided through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This benefit includes:

  • Preventive.
  • Dental.
  • Behavioral health.
  • Developmental and specialty care services.

The American Academy of Pediatrics (AAP) offers guidelines to care for infants, children and adolescents through the Bright Futures website. This website promotes health and prevention with resources and tools just for you and your staff.

Refer to the Bright Futures website at https://brightfutures.aap.org/Pages/default.aspx for tips and tools to help improve children’s health.

  • Recommendations for Preventive Pediatric Health Care Schedule is your guide for preventive care screenings and other children services needed each year.
  • Bright Futures Tool and Resource Kit, 2nd Edition has forms and resources for preventive health.

There are many new and updated tip sheets including age appropriate Staying Healthy Assessment (SHA) to help you implement what is recommended into your daily practice to meet regulatory requirements. The SHA is the Individual Health Education Behavioral Assessment (IHEBA) developed by the Department of Health Care Services (DHCS). The SHA is a required part of the Initial Comprehensive Health Assessment (IHA), which CHWP uses to evaluate Healthcare Effectiveness Data and Information Set (HEDIS®) measures for well-child care.

HEDIS measures

The HEDIS measures below cover issues related to child well-care visits.

  • Well-Child Visits in the First 15 Months of Life: Assesses members who had up to six well-child visits with a primary care physician (PCP) during their first 15 months of life.
  • Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life: Assesses members ages three to six who received one or more well-child visits with a PCP in a year.
  • Adolescent Well-Care Visits: Assesses members ages 12 to 21 who had at least one complete well-care visit with a PCP or an OB/GYN in a year.
  • Children and Adolescents’ Access to Primary Care Practitioners: Assesses members ages 12 months to 19 years who had a visit with a PCP.

For more information about the HEDIS measures, go to www.ncqa.org.

For more information about preventive care, go to www.CAHealthWellness.com.