Special Medicaid Benefits for Children and Youth
The following services are available to children and youth with developmental disabilities:
To request services, call the Office for Citizens with Developmental Disabilities (OCDD) in your area.
DD MEDICAID WAIVER SERVICES
The following services are available to children and youth with developmental disabilities. To request them call the Office for Citizens with Developmental Disabilities (OCDD) District and Authority in your area. Phone numbers are listed on the attachment.
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 Developmental Disabilities Request for Services Registry (DD RFSR) for people with developmental disabilities.
- 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 intellectual disabilities and/or other developmental disabilities. Both waivers 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 that Medicaid usually covers.
- The Children’s Choice Waiver also includes family training. Children remain eligible for the Children’s Choice Waiver until their twentieth birthday, at which time they are moved to an age-appropriate waiver for people with developmental disabilities.
- The Supports Waiver provides specific, activity focused services rather than continuous custodial care. This waiver offers supported employment, day habilitation, prevocational services, respite, habilitation, permanent supportive housing stabilization, permanent supportive housing stabilization transition, and personal emergency response systems.
- The Residential Options Waiver (ROW) is only appropriate for those individuals whose health and welfare can be assured by the support plan with a cost limit based on their level of support need. This waiver offers community living supports, companion care, host home, shared living, one-time transitional services, environmental modifications, assistive technology/specialized medical equipment, personal emergency response systems, respite (center-based), nursing, dental, professional (dietary, speech therapy, occupational therapy, physical therapy, social work, psychology), transportation-community access, supported employment, prevocational services, day habilitation, housing stabilization and housing stabilization transition services.
If you need services for someone 0 to 3 years old, please contact EarlySteps by calling 1-866-327-5978.
A support coordinator 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 support coordination services immediately by calling SRI (toll free) at 1-800-364-7828.
The following benefits are available to all Medicaid eligible children and youth who are under the age of 21 and have a medical need for the service:
Call toll-free 1-877-455-9955 (TTY: 1-877-544-9544) for help with accessing these specialty services. If your child is under 36 months old, call EarlySteps toll free at 1-866-327-5978.
MENTAL HEALTH REHABILITATION SERVICES
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.
PSYCHOLOGICAL AND BEHAVIORAL SERVICES
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.
PERSONAL CARE SERVICES
Personal Care Services (PCS) are provided by attendants when physical limitations due to illness or injury require assistance with eating, bathing, dressing, and personal hygiene. PCS does 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 must be ordered by a physician. The PCS service provider must request approval for the service from Medicaid.
EXTENDED NURSING SERVICES
Children and youth may be eligible to receive Extended 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, they must be ordered by a physician and be prior-authorized by Medicaid.
MEDICAL EQUIPMENT AND SUPPLIES
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.