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Growing Up with Gateway
For Your Children
Parents want the very best health care for their children. Gateway HealthSM does too. With Gateway HealthSM, you can choose a pediatrician (a doctor who sees only children) for your child or you can choose a family doctor (who sees people of all ages). This doctor is your child's primary care physician. This primary care physician (PCP) will get to know your child as he or she grows. The doctor will know your child's medical background. If your child gets sick, call the doctor right away. The doctor will tell you what to do. You can call your Gateway HealthSM doctor 24 hours a day, 7 days a week.
If your child ever needs to see a specialist, your child's Gateway HealthSM doctor will give you a referral to see one. Some of the specialists at Gateway HealthSM see only children.
Gateway HealthSM also lets you choose a dentist for your child. If your child needs to see a dental specialist, your child's dentist will give you a referral to see one. All children with Medical Assistance will be fully covered with Gateway HealthSM's Growing Up with GatewaySM program.
EPSDT means Early and Periodic Screening, Diagnosis, and Treatment. EPSDT is a program that is mandated by the federal government for people under age 21 who get Medical Assistance. The purpose of the EPSDT program is to catch children's health problems early and to keep checking on them.
Gateway Health’s EPSDT program, Growing Up With Gateway℠, follows the Bright Futures schedule- it says how often your child should be seen and what your doctor should be looking for. It also follows the Center for Disease Control’s (CDC) Recommended Immunization Schedule- it says when and what type of shots your child should receive. Please see the Bright Futures Periodicity Schedule and the CDC Recommended Immunization Schedule for more details.
Any Gateway HealthSM member up to the age of 21-is eligible for EPSDT services. The doctor that you choose as your child's primary care physician (PCP) will provide the EPSDT screens and shots/immunizations. All Gateway doctors have a list that shows when the screenings and shots should take place.
There are 11 areas of health that are checked. These areas include: immunizations, vision, hearing, teeth, growth and development, nutrition, heart, lungs, urine test, anemia test and lead screen.
The doctor will also check for the other areas that he or she feels are important. If your child has a medical need, he or she may get other screens too.
Screening tests are important for growing children. The importance of checking eyes, ears, and teeth, is very clear. But children will also be checked in other areas that you might not think of when you think of health care.
Tests will be done to make sure children are growing properly both in body and mind. Speech, social actions, and behavior - the way they relate to kids their age, and the way they relate to others - will all be looked at. The doctor will ask parents questions in order to put together a family medical history.
If your child's doctor finds other areas of concern, your child may get referred for other tests or to other specialists. It is very important that you follow through with scheduling the appointment with the specialist. This will ensure that your child's health issues are being addressed. When you keep your appointment with the specialist, this may help your child from having more problems. If you need help with scheduling, call 1-800-392-1147.
EPSDT Expanded Service
If your child's primary care doctor determines that your child needs medically necessary services or equipment to treat a condition detected during a screening visit, these services and equipment will be covered by Gateway HealthSM. If the service is not normally covered by the Pennsylvania Medical Assistance Program, but is a service that is determined to be medically necessary, it is called an EPSDT Expansion Service and is covered by Gateway.
EPSDT and Immunizations
Gateway HealthSM covers all shots/immunizations for children. These shots help keep children from getting serious illnesses. The doctor should give you a record of which kinds of shots your child gets. It is very important to keep a record of the shots your child gets. If you ever change doctors you should take the record of shots to the new doctor.
You will need to show written proof of your child's shots to enroll your child in day care and preschool programs, and before entering kindergarten. Your child needs to get shots to be protected from diseases as early as possible. Without immunizations some diseases can be deadly. This CDC Recommended Immunization Schedule can be printed so you will know what shots your child needs and when your child needs them.
Getting screens is also important to keep your children healthy. Regular screens are necessary for vision, dental, and hearing. If these screens are kept up to date, problems can be noticed early so your child can get help as early as possible. When problems are not noticed early, serious illnesses can develop. You can ask your doctor if you have any questions.
Lead screens are important, too. Lead can be very dangerous if it is found in a child's blood. When regular screens are done, lead can be noticed early and treated before problems occur.
When your teenager needs a sport, work or drivers license physical, you should take them to their primary care physician for an EPSDT screen. The EPSDT screen can count as your child's sport, work or driver license physical.
Commonly Asked Questions:
I've just had a baby. When should I bring my baby to the doctor?
Your baby's first visit to the doctor will be between birth and two months. Your baby will also need a check up at age 2 months, 4 months, 6 months, 9 months, one year, 15 months, 18 months and at 2 years. Please see the Bright Futures Periodicity Schedule and the CDC Recommended Immunization Schedule for more information about checkups for older children. All these early visits are important to get your baby off to a healthy start.
My teenager is healthy and has all his shots. Does he still need to get an EPSDT every year?
Yes, even children that have all their shots should visit their doctor at least once a year for a screen. This will help keep your teenager healthy and help the doctor catch health problems early.
Can my child still receive shots/immunizations if they have a cold?
Yes, most times your child can receive the necessay shots even if your child has a cold. If you have an appointment scheduled for immunizations or an EPSDT exam and your child gets sick, ask your doctor before you cancel the appointment.
Who do I call if I need help with transportation, scheduling an appointment, or if I have questions about the Growing Up GatewaySM Program?
Call Gateway HealthSM at 1-800-392-1147.
Who do I call if I need to change my child’s doctor or would like a list of doctors in my area?
You can call the Member Services Department at 1-800-392-1147.