Coordination of Children's Health Home Care Management Services, Home and Community Based Services, and Early Intervention Services

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The Medicaid Health Home Serving Children (HHSC) program serves children/youth from birth up to the age of 21 years old who meet two chronic conditions or a single qualifying condition and appropriateness criteria. More information can be found here. To find a Health Home that serves your county can be found here.

The Medicaid Children´s Waiver Home and Community Based Services (HCBS) program serves children/youth from birth up to the age of 21 years old who meet eligibility to receive HCBS to prevent children/youth from hospitalization, residential care, and other higher levels of care or to return them to their community from higher levels of care. HHSC provides the required care coordination services for children/youth who are enrolled in the Children´s Waiver HCBS. More information can be found here.

The Early Intervention Program (EIP) serves infants and toddlers birth to three years old with disabilities or developmental delays and their families. Children must be referred to their local EIP in the county where they reside. Children referred to the EIP with a suspected developmental delay must have a multidisciplinary evaluation to determine eligibility for the Program and must meet State eligibility criteria to receive services. Children referred to the EIP with a diagnosed condition with a high probability of resulting in developmental delay will have a multidisciplinary evaluation to determine outcomes and the services needed to achieve child and family outcomes. Children with or without Medicaid can receive Early Intervention services. A link to the county EIP contact list can be found here.

Children who are referred to the HHSC Program or the EIP and meet the eligibility criteria as mentioned above, for one or both of these programs, can be enrolled in the program(s) and receive all services for which it is determined the child/family is eligible for and those which will best support their needs.

Both the HHSC program and EIP require that the eligible participant have a designated case manager. The HHSC program requires that the Health Home care manager be a qualified and appropriately trained professional who is working in an agency that is State designated to provide Health Home care management services for the HHSC program. The EIP requires that case management for eligible children be provided by an early intervention provider, who has entered into an Agreement with the New York State Department of Health and is considered qualified by Program regulations, to provide initial and/or ongoing service coordination services to children and families in the EIP.

If a child meets the eligibility requirements for both the HHSC program and the EIP, the child can be enrolled in both programs, the case management services must be provided by an agency that is State designated to meet the requirements and training of both as the Health Home care manager (HHCM) AND an Early Intervention Ongoing Service Coordinator (EIOSC).

However, if a child is determined eligible for both the HHSC and EIP, and there is no available dual designated HHCM/EIOSC agency or if any of the dual designated agencies within the area do not have capacity to accept additional cases, the family must be appropriately and fully educated about each of the programs the child is eligible for and make a choice as to which, if either, of the two programs they will enroll their child to facilitate receiving needed services.

Key Points:

  • Children under three years old with a diagnosed condition with high probability of resulting in developmental delay or who are suspected of having a developmental delay, must be referred to the EIP in their county of residence, unless the parent objects to the referral. The EIP designates qualified professionals in accordance with EIP regulations, who have specialized education, appropriate licensure, certification and training, as applicable, to provide needed services for young children and their families. For information about the services provided by the EIP, click here.
  • Children who are enrolled in the EIP and will be aging out and exiting the EIP as of their third birthday, that have Medicaid or who are potentially eligible for Medicaid, should be referred to the Health Home program and the Children´s Waiver for possible continuation of service coordination and linkage to services.
  • Children who may need Medicaid for other services and are currently not Medicaid eligible, may become Medicaid eligible, if first determined to meet the Children´s Waiver eligibility.

It is imperative that children/families are properly educated about the various programs to make an informed choice for service enrollment, especially when a dual designated agency is not available. Choice of the family is paramount.

Questions should be directed to the Health Home program hhsc@health.ny.gov or the Early Intervention Program beipub@health.ny.gov