Home & Community Based Services For Children

Eligibility Criteria:

Nursing Facility Level of Care Criteria:

1. The child is dependent on medical equipment on a daily basis; or

2. Skilled nursing care or comprehensive rehabilitative interventions are necessary, including:
  • Medications are necessary throughout the day
  • There is a high probability for complications or adverse reactions
  • Specialized professional training and monitoring are needed to assist parents
  • The child’s condition substantially interferes with the ability to engage in everyday activities and perform age appropriate activities of daily living at home and in the community
  • The daily routine is altered by the need to complete these specialized treatments or the need for assistance with self care activities.
3. The level of care indicated above shall meet all of the following criteria:
  • The child’s condition is expected to last at least one year
  • Hands on nursing or rehabilitative care must be provided daily
  • The child requires direct hands on assistance to perform treatments.

Hospital Level of Care Criteria:

1. The child has a severe, chronic health condition that is expected to last for at least one year.

2. The child requires a skilled nursing level of care daily including:
  • Hands on medical interventions
  • Rehabilitative care
  • Direct medical monitoring
  • Intense medical regimen
3. The child requires daily medical treatments including:
  • Substantial amount of time to complete
  • Training to perform treatment safely
  • The ability to recognize changes that require prompt interventions
  • The ability to modify treatment plans during the day.

Expedited Criteria:

  1. Children needing an organ transplant
  2. Children on a ventilator
  3. Children in the hospital over 30 days and cannot discharge without services.
  4. Children receiving Hospice

Application Process

Apply for Long Term Care Medicaid:
  • In person at your County Human Services office
  • Apply online
Have an assessment / evaluation by a Utilization Review Contractor / SEP Case Manager.

* An SSI denial letter will be requested from the parent by your case manager and is only needed at the time the child enters the program.

* The final decision on eligibility is determined by the Department of Health Care Policy & Financing (HCPF)