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
 

1. Individuals must meet at least two of the following criteria on a continuing or intermittent basis:
 

a. Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or out of home placement because of conflicts with family or community.
 

 b. Exhibit such inappropriate behavior that repeated interventions by the mental health, social services or judicial system are necessary.
 

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

Therapeutic day treatment is appropriate for children and adolescents who meet one of the following:

a. Children and adolescents who require year-round treatment in order to sustain behavior or emotional gains.

b. Children and adolescents whose behavior and emotional problems are so severe they cannot be handled in self-contained or resource emotionally disturbed (ED) classrooms without:

(1) This programming during the school day; or
(2)This programming to supplement the school day or school year.
 

c. Children and adolescents who would otherwise be placed on homebound instruction because of severe emotional/behavior problems that interfere with learning.
 

 d. Children and adolescents who

    (i) have deficits in social skills, peer relations or dealing with authority;
    (ii) are hyperactive;
    (iii) have poor impulse control;
    (iv) are extremely depressed or marginally connected with reality.

e. Children in preschool enrichment and early intervention programs when the children's emotional/behavioral problems are so severe that they cannot function in these programs without additional services.