What is Texas Health Steps?

Children in DFPS conservatorship, including children in foster care and kinship care, must get Texas Health Steps medical and dental checkups. The Texas Health Steps program, known in federal law as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, is Medicaid’s preventive healthcare program for children, teens, and young adults age 20 and younger. Texas Health Steps checkups are designed to find and treat medical and dental problems. Only licensed providers who are enrolled in Texas Health Steps may do Texas Health Steps checkups.

How often the child gets Texas Health Steps medical checkups depends on the child’s age. Children and youth age 3 through 20 years need medical checkups every year. Children under 3 years of age need more frequent medical checkups.

Texas Health Steps medical checkups must include regularly scheduled examinations and screenings of the general physical and mental health, growth, development, and nutritional status of infants, children, and youth. Texas Health Steps medical checkups must occur in accordance with the Texas Health Steps Periodicity Schedule.  There are 11 checkups before 3 years of age (excluding the newborn exam), and annually from 3 through 20 years of age.

A Texas Health Steps medical checkup must include the following age-appropriate components:

  • Comprehensive health and developmental history that includes nutritional, developmental, mental health, and tuberculosis (TB) screenings.
  • A comprehensive unclothed physical examination.
  • Vision screening.
  • Hearing screening.
  • Immunizations appropriate for age and health history.
  • Oral health screening and referral to a dental home.
  • Age-appropriate and risk-based laboratory testing as noted on the Texas Health Steps Periodicity Schedule and  testing for certain conditions based on an identified risk or at the provider’s discretion (e.g.,┬áHyperlipidemia, Type 2 Diabetes, STD, HIV.)
  • Health education and appropriate anticipatory guidance.
  • Referrals to other health-care providers as needed.

The Texas Health Steps Dental Program provides preventive, treatment, emergency, and orthodontic care for children 6 months through 20 years of age.  Texas Health Steps dental checkups are recommended every 3-6 months, starting at 6 months of age. The Texas Health Steps dental program includes the following services:


  • Dental examinations (initial or periodic)
  • Cleaning (prophylaxis)
  • Oral health education
  • Application of topical fluoride
  • Application of sealants to certain teeth
  • Maintenance of space


  • Restorations (fillings, crowns)
  • Endodontic treatment (pulp therapy, root canals)
  • Periodontic treatment (gum disease)
  • Prosthodontics (full or partial dentures)
  • Oral surgery (extractions)
  • Implant services and Maxillofacial prosthetics


  • Procedures necessary to control bleeding, relieve pain, and eliminate acute infection
  • Procedures that are required to prevent imminent loss of teeth
  • Treatment of injuries to the teeth or supporting structures


  • Correction of cleft palate
  • Crossbite therapy
  • Treatment for severe, handicapping malocclusion
  • Treatment for facial accidents involving severe traumatic deviation

A more complete description of the Texas Health Steps program can be found at www.dshs.texas.gov/thsteps/about.shtm

A printable copy of the Texas Health Steps Periodicity schedule can be found at

More complete information on the Texas Health Steps Dental Program can be found at http://www.dshs.texas.gov/dental/thsteps_dental.shtm

Comprehensive Care Program (CCP)

In accordance with the Federal EPSDT program, the Texas Health Steps Comprehensive Care Program (CCP) provides all medically necessary treatment for correction of any physical or mental problems.

  • Texas Health Steps--CCP services are included in the STAR Health Program for children in DFPS care and for young adults enrolled through Medicaid for Transitioning Foster Care Youth (MTFCY.)
  • Texas Health Steps--CCP services are available through Star Health and Traditional Medicaid.

For more information regarding Texas Health Steps:

  • Call STAR Health at 1-866-912-6283;
  • Call a Texas Health Steps outreach counselor at 1-877-THSTEPS (1-877-847-8377);
  • Visit the STAR Health website
  • Visit the About Texas Health Steps page on the Texas Department of State Health Services (DSHS) website.

Requirements for Medical and Dental Checkups


A child’s first Texas Health Steps medical checkup must occur within 30 days after the child comes into DFPS conservatorship, regardless of the child’s age. The checkup is considered overdue 31 days after removal.

After that, children and youth age 3 to 20 years old must receive a Texas Health Steps medical checkup annually. Children who are younger than 36 months of age must get Texas Health Steps medical checkups more often, as outlined in the Texas Health Steps periodicity schedule.


For children enrolled in STAR Health who are 6 months and older, the first Texas Health Steps dental checkup must occur within 60 days after their entry into DFPS conservatorship.  The checkup is considered overdue 61 days after removal.

Children who turn 6 months old while in DFPS care must have their first Texas Health Steps Dental Checkup within 30 days of turning 6 months old. The checkup is considered overdue 31 days after turning six months old.

After that, children should get Texas Health Steps dental checkups every 6 months. The checkup is due 6 months after the month in which the child received the previous checkup.

Children 6 through 35 months of age who are identified by their dentist as being a moderate to high risk for the development of early childhood caries (cavities) may get regular dental checkups on a more frequent basis such as every 3 months.