Medicaid Managed Care Services

• Children/Youth must be under 21 years old
• Eligible for Medicaid (If you or your child do not already have Medicaid, please contact The Children and Youth Evaluation Service (C-Yes) at 1-833-333-CYES (1-833-333-2937)
• A Health Home Care Manager or C-Yes must complete an HCBS eligibility assessment
• The Children and Youth Evaluation Service (C-YES) is a statewide program that determines whether a child/youth (under age 21) is eligible for Home and Community Based Services (HCBS) for children who do not currently have Medicaid or for children who opt-out of the Health Home Serving Children’s program.

• Children with Serious Emotional Disturbance (SED)
• Children with a Developmental Disability (DD) in Foster Care
• Children who are Medically Fragile (MedF)
• Children who are Medically Fragile (MedF) with a Developmental Disability (DD)

The array of services is intended to assist children/youth in being successful at home, in school, and in their other natural environments to help maintain them in their community and avoid higher levels of care and out-of-home placements.

• Community and Family Supports – assistance in navigating complex systems (i.e. schools, hospitals); advocacy/access for needed resources; support with complex family dynamics; community-based skills training for children/youth; transitional support
• Employment Services – youth build job-ready skills that can be used in any work environment; specific skills training up to and including job shadowing
• Planned Respite – planned breaks for caregivers and their children; use of time can include skill-building and/or recreation

• Children and youth must be eligible for or enrolled in Medicaid or Medicaid Managed Care and reside in a home or community-based setting, or they must have Child Health Plus coverage

• Children 0-21 years old that have social, emotional, and/or behavioral health needs.

We provide three main services for children and families.  Clients can receive any and all services below based on need and medical necessity.

Other Licensed Practitioner / Licensed Clinician (OLP)

• Therapy can be provided in the home- individual, family, etc. Youth that have a treating therapist in clinic can still receive this service but it cannot be a duplication of service.
• Evaluations and Assessments

Community Psychiatric Supports and Treatment (CPST)

• Identify skills for future crisis and identify precursors or triggers. Supports youth/family after a crisis .
• Provide education to youth, family members or collaterals to maintain youth in the community (Example: triggers, coping skills etc.)
• Assist the youth, family and collaterals to identify resources in the community, associated with the identified needs.
• Improving life skills-making appointments, access to emergency services, basic safety practices, etc.

Psychosocial Rehabilitation (PSR)

• Increase social and interpersonal skills, daily living skills and community integration.

• Children/Youth from birth to age 21
• Must be enrolled in Medicaid
• Must meet one of the following criteria for eligibility:
  • Serious Emotional Disturbance (Axis 1 Diagnosis)
  • Two Chronic Conditions (Only one of which can be a developmental diagnosis)
  • HIV/AIDS
  • Complex Trauma (client will be assessed for this in the absence of a diagnosis in one of the above categories)
  • Must have functional limitations related to their eligibility criteria
  • Sickle Cell Disease

• Children/Youth from birth to age 21

The Health Home Care Manager shares health records among providers so that services are not duplicated or neglected. 

The core services include:

• Comprehensive Health Home Care Management
• Care Coordination and Health Promotion
• Comprehensive Transitional Care
• Individual and Family Support
• Referral to Community and Social Services