Medicaid Eligibility Criteria for In-Home Services

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

Two of the following must be clearly documented for the individual on a continuing or intermittent basis…..

1. Problems in establishing / maintaining interpersonal normal relationships such that are at risk of hospitalization or out-of-home placement because of conflicts with family or community;

2. Show such inappropriate behavior that repeated interventions by mental health, social services or judicial system are necessary;

3. Demonstrate such difficulty in cognitive ability that they are unable to recognize personal danger or recognize significantly inappropriate social behavior.

Services are necessary when at risk of out-of-home placement and at least one of the following criteria are met…

1. Service far more intensive than outpatient care is required to stabilize the child in the family situation; (provider should identify treatments tried / explored in the past 6 months and indicate if they were successful / unsuccessful)

2. The child’s home is more likely to be successful as the setting for treatment than a clinic (describe why this is true)

Some other eligibility criteria are . . .

• At least one parent with whom the child is living must be willing to participate in In-Home treatment, with the goal of keeping the child with the family.
• These services may also be used to facilitate the transition to home from an out-of-home placement.