MassHealth's Preventive Pediatric Healthcare Screening and Diagnosis Benefit

The Preventive Pediatric Healthcare Screening and Diagnosis (PPHSD) benefit covers the preventive care of MassHealth Family Assistance members younger than 21.

If you are a MassHealth Standard or CommonHealth member, please visit the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Benefit page.

If you are a provider, please visit the EPSDT and PPHSD Information and Resources page.

What is included in the PPHSD benefit?

The PPHSD benefit covers

• well-child checkups including age-appropriate vision, hearing, behavioral health, developmental, and immunization status screenings; and
• dental checkups.

Services provided under PPHSD benefit are free (except for any MassHealth premiums you may pay). All coverage is subject to the conditions and limitations of MassHealth regulations.

After each checkup, talk to your primary care provider or dentist about any other treatment you may need. They can refer you to another provider or specialist. MassHealth or your health plan will pay for any covered services needed to treat a medical, behavioral, vision, or dental health need.

For some services, your provider may need to submit a special request, called a prior authorization (PA) request. MassHealth or your health plan will review the request to determine if there is a medical need for the service. They will then approve or deny the request.

• If you disagree with a decision to deny a request, you have a right to appeal the decision.
• To learn more about the appeal process, you can refer to your member handbook or contact My Ombudsman.

Family Assistance members are not eligible for non-emergency medical transportation.

How to receive benefits

MassHealth members may receive their benefits in one of two ways.

1. A health plan is usually responsible for managing your care on behalf of MassHealth.

• If you have a health plan, you should have received a health plan ID card. Your ID card includes your health plan’s customer service number. You can also call the MassHealth Customer Service Center at [phone], TDD/TTY: 711.

• Learn more about the different types of MassHealth health plans available in the MassHealth Enrollment Guide.

2. In some cases, MassHealth directly manages your benefits.

• You will only receive a MassHealth ID card and should call MassHealth Customer Service for help at [phone], TDD/TTY: 711. 

Well-child checkups

It’s important for children, teens, and young adults to get regular checkups (also known as well-child checkups) with their primary care provider. Small problems that are found early can be taken care of before they become bigger problems. If you need help finding a primary care provider, you can call your health plan or the MassHealth Customer Service Center at [phone], TDD/TTY: 711.

MassHealth recommends well-child checkups at the following ages (based on guidance from the American Academy of Pediatrics).

• Before Age 1: Newborn (may occur in the hospital before discharge), 3–5 days, by 1 month, 2 months, 4 months, 6 months, and 9 months
• Ages 1–2 years: 12 months, 15 months, 18 months, 24 months, and 30 months
• Ages 3–21 years: Once per year

What happens during a well child checkup?

During a well-child checkup, your primary care provider should do a full physical exam. They should also do the following.

• Ask about your health history, including
  • family history;
  • birth, growth, and nutrition history;
  • medications you take or have taken;
  • allergies, including medication allergies; and
  • medical history, including past illnesses.
• Make sure your immunizations (also called vaccines or shots) are up to date.
• Immunizations are a safe, effective way to prevent many diseases, hospitalizations, deaths, and even some cancers.
• Different immunizations are recommended at different ages. Some, like flu shots and COVID-19 boosters, may be needed every year to stay protected.
• MassHealth covers immunizations provided at the doctor’s office and at other locations. You can call the MassHealth Customer Service Center at [phone], TDD/TTY: 711 or your health plan for help finding the best place to get your shots.
• Measure height and weight.
• Check blood pressure (usually starting at age 3 and then every year).
• Check hearing and vision (usually starting at age 3 or 4 and then at later well-child checkups).
• Conduct age-appropriate developmental and behavioral health screenings, including screening for
  • depression in parents and other infant caregivers (through the child’s 12-month visit);
  • Autism Spectrum Disorder (at 18 and 24 months);
  • development (at 9, 18, and 24 months, and as needed);
  • tobacco, alcohol, and drug use (beginning at age 11); and
  • depression (beginning at age 12).
• Check dental health and, if needed, apply fluoride varnish (a treatment that helps prevent tooth decay).

Dental checkups and other dental services

MassHealth recommends dentist visits every six months. Babies should start seeing the dentist when their first tooth comes in, or by the time they turn 12 months old. MassHealth covers many dental services if they are provided by a dentist who accepts MassHealth. Such services include the following.

• Cleanings
• X-rays
• Braces
• Fillings
• Crowns
• Root canals
• Extractions (tooth removal)
• Oral surgery

For more information on MassHealth dental coverage or to find a dentist, you can call Dental Customer Service at [phone], TDD/TTY: 711, or visit Learn about MassHealth dental benefits.  

Resources

Questions?

All members can call the MassHealth Customer Service Center at [phone], TDD/TTY: 711. If you have a health plan, you can also call the customer service phone number on your health plan ID card.

For information about disability accommodations, language assistance, and other communication help, visit Communicating with MassHealth.

Other Resources

• To find out more about MassHealth for children, visit MassHealth for children and young adults.
• My Ombudsman is an independent program for all MassHealth members. My Ombudsman can help if you have questions or need help getting benefits or services from MassHealth or your MassHealth health plan. They provide information about MassHealth benefits and rights, listen to concerns, and help address problems. My Ombudsman can also explain how to file a grievance or appeal, but they cannot represent members in these processes.
  • For more information, visit My Ombudsman. You can also email [e-mail], call [phone], or connect by videophone at [phone] (for Deaf and Hard of Hearing members).
• The Women, Infants, and Children (WIC) Nutrition Program provides free nutrition and health education, healthy food, and other services to pregnant and breastfeeding people and to infants and children under age five. For more information about WIC, call [phone], TDD/TTY: 617-624-5992 or visit the WIC webpage.
• For information about resources available through the Department of Transitional Assistance, including direct economic help (cash benefits) and food help (SNAP benefits), call [phone] or visit the DTA webpage.

Date published:	July 18, 2025