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Staying Healthy Assessment Requirement
This requirement applies to all managed Medi-Cal members.
The initial health assessment includes the Initial Health Education Behavioral Assessment (IHEBA) which utilizes the “Staying Healthy Assessment”(SHA) form. The SHA forms are produced by DHCS and consist of 9 specific age categories (0-6 months, 7-12 months, 1-2 years, 3-4 years, 5-8 years, 9-11 years, 12-17 years, adult and seniors).
The assessment is designed to be completed by members age 12 and over and by parents for ages 11 and under, while waiting for their medical visit. If a member or parent requests help with completion, it must be provided. This assessment is designed to initiate dialogue between member and provider facilitating focused health education counseling addressing health behavior change.
This assessment must be completed with all new members within 120 days of enrollment into the plan. It must also be done with all existing patients at their next non-acute care visit and when entering into a new age category.
Staying Healthy Assessment Resources
- Click here to view the Staying Healthy Assessment Provider Training video
- Click here for the Staying Healthy Assessment Training Attestation Sign-in Form
Staying Healthy Assessment Forms ()
See links below for Staying Healthy Assessment forms in English, Spanish, Arabic, Farsi, Khmer, Somali, Armenian, Chinese, Hmong, Korean, Russian, Tagalog and Vietnamese
If you are unable to access the forms please contact your Provider Services representative.
Alternative Forms or Electronic Formats
If you are planning to use an alternative to the SHA forms and/or converting the SHA forms into an electronic format, please complete the request form below and submit it to Molina at least one month before using the alternative form(s).
SHA Electronic or Other Format Notification Form
Use of Bright Futures Notification Form
Alternative IHEBA Notification FormSmoking Cessation Resources
Support Groups and Classes
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