Current through Register Vol. 18, September 20, 2024
(1) A
child who is receiving Medicaid or is presumptively eligible for Medicaid is
eligible for targeted case management services for children and youth with
special health care needs if the child meets one of the requirements in (a) or
(b) and meets one of the requirements in (c).
(a) The child is under the age of one and
meets one of the following:
(i) was born to a
mother who abused drugs or alcohol during her pregnancy;
(ii) was born prior to 37 weeks
gestation;
(iii) was born at a
birth weight of less than 2500 grams; or
(iv) the department has care and placement
authority, a voluntary services agreement, an in-home service agreement or a
voluntary placement agreement with the parent/guardians.
(b) The child is birth through 18 years of
age and meets one of the following:
(c) has one or more of the following physical
health conditions that is expected to last at least 12 months:
(i) is infected with the human
immunodeficiency virus (HIV), as determined by a positive HIV antibody or
antigen test, or who has a diagnosis of HIV disease or AIDS;
(ii) has been diagnosed with a congenital
heart condition;
(iii) has been
diagnosed with a neurological disorder or brain injury;
(iv) has been diagnosed with a condition that
requires use of a ventilator;
(v)
has been diagnosed with a condition that causes paraplegia or
quadriplegia;
(vi) has been
diagnosed with another chronic physical health condition that is expected to
last at least 12 months and causes difficulty performing activities of daily
living; or
(vii) has been diagnosed
with failure to thrive in the past year.
(c) The child is at high risk for medical
compromise due to one of the following:
(i)
failure to take advantage of necessary health care services;
(ii) noncompliance with their prescribed
medication regime;
(iii) an
inability to coordinate multiple medical, social, and other services.
(iv) a lack of community support system to
assist in appropriate follow-up care at home.
(2) Initial assessment of children covered by
these special health care needs targeted case management services may occur in
the hospital following the infant's birth. This assessment must be followed by
a referral to appropriate service providers in the community. Assessments by
all professionals will be accepted, shared, and integrated into planning for
all children covered by these services.
