Special Needs Children

The following services are available to children and youth with developmental disabilities. To request them call the Regional Administrative Unit (RAU) in your area.

To sign up for "waiver programs" that offer Medicaid and additional services to eligible persons (including those whose income may be too high for other Medicaid), ask to be added to the Mentally Retarded / Developmentally Disabled, "Request for Services Registry." The New Opportunities Waiver (NOW) and the Children's Choice Waiver both provide services in the home, instead of in an institution, to persons who have mental retardation and/or other developmental disabilities. Both cover Family Support, Center-Based Respite, Environmental Accessibility Modifications and Specialized Medical Equipment and Supplies. In addition, NOW covers services to help individuals live alone in the community or to assist with employment, and professional and nursing services beyond those Medicaid usually covers. The Children's Choice Waiver also includes Family Training. Children remain eligible for the Children's Choice Waiver until their nineteenth birthday, at which time they will be transferred to an appropriate Mentally Retarded and Developmentally Disabled Waiver.

(If you are accessing services for someone 0-3 please contact Early Steps at 1-866-327-5978 )

A case manager works with you to develop a comprehensive list of all needed services (such as medical care, therapies, personal care services, equipment, social services and educational services) then assists you in obtaining them. If you are a Medicaid recipient and under the age of 21 and it is medically necessary, you may be eligible to receive case management services immediately.

The following benefits are available to all Medicaid-eligible children and youth under the age of 21 who have a medical need. To access these services, call the Specialty Care Resource Line toll-free at 1-877-455-9955 (TTY 1-877-544-9544).

Children and youth with mental illness may receive Mental Health Rehabilitation Services. These services include: clinical and medication management; individual and parent/family intervention; supportive and group counseling; individual and group psychosocial skills training; behavior intervention plan development and service integration. All mental health rehabilitation services must be approved by mental health prior authorization unit.

Children and youth who require psychological and/or behavioral services may receive these services from a licensed psychologist. These services include necessary assessments and evaluations, individual therapy and family therapy.

Medicaid recipients under the age of 21 are eligible for checkups ("EPSDT screens"). These checkups include a health history; physical exam; immunizations; laboratory tests, including lead blood level assessment; vision and hearing checks; and dental services. They are available both on a regular basis, and whenever additional health treatment or services are needed. EPSDT screens may help to find problems that need other health treatment or additional services. Children under 21 are entitled to receive all medically necessary health care, diagnostic services and treatment and other measures covered by Medicaid to correct or improve physical or mental conditions. This includes a wide range of services not covered by Medicaid for recipients over the age of 21.

Personal Care Services are provided by attendants when physical limitations due to illness or injury require assistance with eating, bathing, dressing and personal hygiene. PCS services do not include medical tasks such as medication administration, tracheostomy care, feeding tubes or catheters. The Medicaid Home Health program or Extended Home Health program covers those medical services. PCS services must be ordered by a physician. The PCS service provider must request approval for the service from Medicaid.

Children and youth may be eligible to receive Skilled Nursing Services in the home. These services are provided by a Home Health Agency. A physician must order this service. Once ordered by a physician, the home health agency must request approval for the service from Medicaid.

PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, AUDIOLOGY SERVICES, and PSYCHOLOGICAL EVALUATION AND TREATMENT

If a child or youth wants rehabilitation services such as Physical, Occupational, or Speech Therapy, Audiology Services or Psychological Evaluation and Treatment; these services can be provided at school, in an early intervention center, in an outpatient facility, in a rehabilitation center, at home or in a combination of settings, depending on the child's needs. For Medicaid to cover these services at school (ages 3 to 21), or early intervention centers and EarlySteps (ages 0 to 3), they must be part of the IEP or IFSP. For Medicaid to cover the services through an outpatient facility, rehabilitation center or home health agency, they must be ordered by a physician and be prior-authorized by Medicaid.

For information on receiving these therapies, contact your school or Early Intervention Center. EarlySteps can be contacts (toll-free) at 1-866-327-5978. Call the Specialty Care Resource Line at 1-877-455-9955 to locate other therapy providers.

Children and youth can obtain any medically necessary medical supplies, equipment and appliances needed to correct or improve physical or mental conditions. Medical Equipment and Supplies must be ordered by a physician. Once ordered by a physician, the supplier of the equipment or supplies must request approval for them from Medicaid.

Transportation to and from medical appointments, if needed, is provided by Medicaid. These medical appointments do not have to be with Medicaid providers for the transportation to be covered. Arrangements for non-emergency transportation must be made at least 48 hours in advance.

Persons under age 21 are entitled to receive all medically necessary health care, diagnostic services, treatment and other measures that Medicaid can cover. This includes many services that are not covered for adults.

If you need a service that is not listed above, call the Coordinator at the Specialty Care Resource Line toll-free at 1-877-455-9955 (TTY 1-877-544-9544). If they cannot refer you to a provider of the service you need, call 888-758-2220 for assistance.