Medicaid Eligibility Criteria for Day Treatment Services

According to recent Medicaid guidelines, in order for children to receive Medicaid funding they must meet following criteria:

Client must meet two of the following criteria:

·         The child is at imminent risk of being removed from the home or hospitalized due to the child’s severe behavior impairments.

·         The child has had repeated interventions within the mental health or judicial system.

·         The client is unable to recognize personal danger or significantly inappropriate social behavior.

Client must meet one of the following criteria:

·         The client requires year-round treatment to sustain behavioral or emotional gains.

·         The client has problems so severe that they cannot be maintained in self-contained or resource (ED) classrooms without programming during the school day or as supplement to school day?

·         The client would otherwise be placed on homebound instruction due to severe emotional or behavioral problems that interfere with learning.

·         The client has emotional or behavioral problems so severe the child cannot function in preschool enrichment or early intervention programs without additional services.

·         The client has deficits in social skills, peer relations, dealing with authority, hyperactivity, poor impulse control, extremely depressed, or are marginally connected with reality.