Texas Health Steps

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, also known as Texas Health Steps, is the Medicaid health care program for children, teens and young adults, birth through 20 years old. It provides preventive health care at no cost to you. This program is available to Superior HealthPlan STAR, STAR+PLUS, STAR Kids and STAR Health members.

Similarly, American Academy of Pediatrics recommended well-child exams and preventive health services are available to CHIP members.

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Texas Health Steps and well-child visits give your child:

Free regular medical checkups starting at birth.
Free dental checkups starting at 6 months of age. You do not need a referral from your doctor for dental services.
A Care Manager who can find out what services your child needs and where to get these services.

Regular medical checkups help make sure children grow up healthy. Children should be taken to their doctor or another Superior Texas Health Steps provider for these checkups. Children should also get regular dental checkups to make sure their teeth and gums are healthy.

To help you make sure your doctor has the information he or she needs for a Texas Health Steps appointment, please fill out one of the well-visit forms on our Helpful Forms & Links webpage before your appointment.

For STAR, STAR Health, STAR Kids and STAR+PLUS members:

Read more about this program on the Texas Health and Human Services Commission (HHSC) Texas Health Steps website or in your Superior Member Handbook. You can also call Texas Health Steps at 1-877-847-8377.

If you can’t get your child to the checkup, Superior may be able to help. Check out Superior's Medical Ride Program.

Texas Health Steps and
Well-Child Visit Toolkit

Preventive Visits and Screenings

Well-child visits are an essential part of a child’s health. Attending routine visits can help to monitor a child’s overall health and development. Well child visits should be performed from birth to 20 years old under the EPSDT benefit.

The table below contains the most common preventive health screenings for children and adolescents. These screenings must be provided at well-child visits.

Preventive Health Screenings

Anemia Screen	An anemia screen is a blood test that identifies those who have or are at risk of developing an iron deficiency.
Behavioral Health Screen	A behavioral health screen is done to identify and manage mental health conditions. Early detection is important to prevent some effects caused by a childhood mental disorder.
Comprehensive Unclothed Physical Exam	An age-appropriate unclothed physical exam is required at each checkup to assess growth and development.
Dental Screen	During regular well-child visits, the pediatrician will complete an oral screening to check your child’s teeth and gums. In addition to the oral screening, it is recommended that children visit their dentist every 6 months for a dental checkup.
Developmental Screen	A developmental screen is done to see how your child is growing. Developmental screens can be a brief test or questionnaire. These screenings are completed from birth through 6 years old. Autism screening is required at 18 months and again at 24 months as part of a developmental screen.
Diabetes Screen	A diabetes screen is a blood test to screen for type 2 diabetes.
Dyslipidemia Screen	This is a blood test to check for cholesterol levels.
Health Education	Health education and counseling with parents or guardians and clients are required to assist parents in understanding what to expect about their child’s development. They also provide information about the benefits of healthy lifestyles and practices.
Hearing Screen	A hearing screen is done to identify early and manage hearing loss. These screenings can take place in several settings such as school, home, or medical settings.
HIV/Sexually Transmitted Infection Screen (STI)	The pediatrician completes an HIV/STI screen by getting a sexual history to determine if there is a risk for HIV/STI. The pediatrician may offer testing if an increased risk is identified.
Immunizations	The doctor will assess the immunization status at every medical checkup to ensure all age requirements have been met. Unless the doctor identifies a medical reason or there are religious beliefs that prevent the child from getting their vaccine, the necessary vaccines must be given.
Lead Screen	This is a blood test to check to see if a child had exposure to lead. If the lead level is high, follow up is recommended that may include testing and treatment to remove lead from the body.
Mental Health Screen	A mental health screen is done to identify and manage mental health conditions. Early detection is important to prevent some effects caused by a childhood mental disorder.
Newborn Screen	A blood test to check for any medical condition when the child is born. This is done to find and treat any disorder early to prevent serious complications, such as growth problems or developmental delays.
Nutritional Screen	A nutritional screening is completed with each visit to identify any nutritional issues or concerns.
Postpartum Depression Screen	A postpartum depression screening is completed with the mother of the child at the child’s visits from birth to 12 months.
Tuberculosis Screen (TB)	This assessment is checks if someone has been exposed to the bacteria that causes tuberculosis. If a risk is identified, a skin test will be done to verify.
Vision Screen	A vision screening is a brief eye and vision check to help identify vision issues.

See the dropdowns below for additional resources and information
about these screenings and when children should get them.

Child visits should be scheduled as shown in the table below.

Each visit should include:

A physical exam (length, weight and hearing/vision)
Health history
Any recommended screens
Immunizations
Referrals to specialists (if needed)

Exam Schedule
Newborn	12 months
Discharge to 5 days	15 months
2 weeks	18 months
2 months	24 months
4 months	30 months
6 months	3 years old
9 months

Review the Centers for Disease Control (CDC) Child and Adolescent Immunization Schedule to learn which vaccines children need to receive from infancy to 3 years old.

Required Screenings

Anemia Screen	An anemia screen should be performed at 12 months.
Autism Screen	An autism screen is required at 18 and 24 months. Catch up screens can be completed during your 30-month visit.
Dental	A dental screen should be completed at the 6-month and 12-month exam. The screening is required for every 6 months after the first visit until the child is 20 years old.
Developmental Screen	A developmental screen is required at 9 and 18 months. An additional developmental screen is required for STAR, STAR Kids, and STAR Health members at 24 months and 30 months for CHIP members
Hearing	All newborns should have their hearing examined during their first visit. Follow-up or referrals should be conducted based on results.
Lead Screen	A lead screen is required at 12 and 24 months. Children between 36-72 months must be tested if they have not already been tested.

Well-child visits include health education from your doctor. For newborns to children 3 years old, some topics they may discuss include:

Age-appropriate car safety information
Bedtime routines
Establishing ongoing care with a dentist
General baby safety

For more information, STAR, STAR Kids and STAR Health members can visit the Texas Health Steps Parent and Child Anticipatory Guidance webpage. CHIP members can find information here on the American Academy of Pediatrics website.

Your child should see their provider once per year between the ages of 4 and 8 years old. This exam is for vaccinations and to check for any early signs of disease. You can use this visit to ask questions about your child’s ongoing health.

Each visit should include:

A physical exam (length, weight and hearing/vision)
Health history
Any recommended screens
Immunizations
Referrals to specialists if needed

Review the Centers for Disease Control (CDC) Child and Adolescent Immunization Schedule to learn which vaccines your child needs to receive at between the ages of 4 and 8 years old.

Required Screenings

Behavioral Health	Performed at each checkup from birth through 20 years old.
Dental Screening	An oral screening must be performed at each EPSDT well-child visit. Children should also visit their dentist every 6 months for a dental checkup.
Hearing Screening	Hearing screenings will be completed each year for children 4 through 6 years old, and again at 8 years old. The doctor will also check hearing any other time there’s a concern.
Vision Screening	A vision screening will take place at 3 through 6 years old and again at 8 years old.

Well-child visits include health education from your doctor. For children between the ages of 4 and 8 years old, some topics they may discuss include:

Age-appropriate car safety information
Physical activity
Limiting TV and screen time
Consistent routines

Preteens and teens should see their doctor once per year. This exam is for vaccinations and to check for early signs of disease. Use this annual visit to ask any questions about a teen’s ongoing health. Remember to also make sure teens visit the dentist twice per year.

Each visit should include:

A physical exam (length, weight and hearing/vision)
Health history
Any recommended screens
Immunizations
Referrals to specialists, if needed

Review the Centers for Disease Control (CDC) Child and Adolescent Immunization Schedule to learn which vaccines children need to receive at between the ages of 9 and 13 years old.

Required Screenings

Behavioral Health Screening	Performed at each checkup from birth through 20 years old.
Dental Screening	Performed at each checkup. Dental visit twice per year.
Dyslipidemia Screening	Is required once at 9 through 11 years old.
Hearing Screening	Performed at each checkup from birth through 20 years old.
Vision Screening	Performed during every periodic screening assessment at 10 and 12 years old.

Preteens need proper health education and preventive counseling for growth and development into the teenage years. Encouraging healthy behaviors will ensure a smooth transition. This includes:

Eating: Preteens should have 3 meals with 1-2 healthy snacks a day.
Sleeping: Preteens need a recommended 9-12 hours of sleep.
Physical Activity: At least 60 minutes of physical activity every day.

Teens and young adults between the age of 14 and 20 years old should visit their doctor once a year to monitor their overall health and development. During these yearly visits the doctor may ask parents/guardians to leave the room when completing the physical exam. This gives teens the opportunity to develop a relationship with their doctor and the privacy to ask and answer questions.

The doctor will pay close attention to behaviors and emotions to address issues related to depression, tobacco, alcohol or drugs, violence and/or eating disorders. Attending these routine visits helps to encourage teens to develop healthy behaviors and reduce or prevent unhealthy behaviors.

Required Screenings

Dental Screening	An oral screening must be performed at each EPSDT well-child visit. Teens and older children should also visit their dentist every 6 months for a dental checkup.
Dyslipidemia Screening	This screening is required once between 18 through 20 years old.
Hearing Screening	Hearing screenings should be performed at one visit between 11 and 14 years old, one visit between 15 through 17 years old, and one visit between 18 through 21 years old. The doctor will also check hearing any other time there’s a concern.
*HIV/STI Screening	Teens should be screened for STIs between 11 through 20 years old, based on risk, making every effort to maintain confidentiality. An HIV test should be completed once from 16 through 18 years old (from 15 through 18 years old for CHIP).
Mental Health Screening	A mental health screening is completed for teens 12 through 18 years old.
Vision Screening	A vision screening will take place at 15 and 20 years old.

*The HIV/STI screening is recommended but not required.

Encouraging healthy behaviors will help teens transition into young adults. This includes:

Teaching them how to prepare for their doctor's visits.
Assisting them with scheduling appointments, filling out medical forms, and becoming knowledgeable about any medical conditions they may have.
Obtaining information for them on protection against STDs, STIs and pregnancy before they become sexually active.
Informing them on signs of depression, anxiety, or other behavioral health issues and how to discuss with their parents, trusted adult or doctor, if needed.
Limiting sweets, sodas and high-fat foods. Support them in eating nutritious meals and snacks each day.

Texas Health Steps

Texas Health Steps and Well-Child Visit Toolkit

Preventive Visits and Screenings

Birth to 3 Years Old

4 to 8 Years Old

9 to 13 Years Old

14 to 20 Years Old

Texas Health Steps and
Well-Child Visit Toolkit