Students with complex physical health needs may be eligible for medically necessary services under the Medicaid Health Plan managed by DHS. One of the health benefits under the Medicaid Health Plan is Case Management Services for certain children with complex physical health needs.
Section 1905(a)(19) and 1915(g)(2) of the Social Security Act define Case Management as services which will assist an individual eligible in gaining access to needed medical, social, educational, and other services. Activities commonly understood to be allowable include:
There are various types of Case Management Services within DHS for children with complex physical health needs, which include:
The agency assigned to provide the Medically Fragile Case Management Services is the primary case manager for the child and is responsible to collaborate with public health nurses, physicians, and other community providers in coordinating the care the child will need when he/she is in the home. These services also include collaboration and coordination of non-health care services such as educational and recreational services.
Community-Based Waiver Programs for Children with Special Health Needs are under the DHS. Children must be eligible for Medicaid. (Parent’s income is NOT considered when making determination for Medicaid eligibility). Additionally, the child must be determined to be at a subacute or skilled nursing care facility level of care and can be cared for safely and cost effectively outside of a medical facility. Refer to the following summaries of waiver programs (see Appendix B).
Community-Based Waiver Program for Children and Adults with Diagnosis of Mental Retardation/Developmental Disabilities under the DOH. Clients must be Medicaid eligible.
In addressing the comprehensive needs of the child, the DOE staff and Public Health Nurse (PHN) working with the child during the school day should include the case manager of the case management agency involved with the child and family. DOE staff and/or PHNs should work with the family to ascertain if any case management agency is involved and providing services to the child and family.