Eligibility for Medicaid Waiver Services

Wayne County Office of Behavioral and Developmental Programs and Early Intervention shall ensure that infants and toddlers with disabilities enrolled in the Infant, Toddlers and Families Medicaid Waiver meet the level of care criteria for an intermediate care facility/mental retardation (ICF/ID) or intermediate care facility/other related conditions (ICF/ORC) as set forth in subsection (b).

Minimum Eligibility

Minimum eligibility for ICF/ID or ICF/ORC level of care is established by one of the following:

• A licensed psychologist, certified school psychologist or licensed physician shall certify that the infant or toddler has significantly subaverage intellectual functioning which is documented by one of the following:
  • Performance that is more than two standard deviations below the mean as measured on a standardized general intelligence test.
  • Performance that is slightly higher than two standard deviations below the mean as measured on a standardized general intelligence test during a period when the infant or toddler manifests serious impairments of adaptive behavior.
• A qualified professional who meets the criteria in 42 CFR 483.430(a) (relating to condition of participation: facility staffing), shall certify that the infant or toddler has other related conditions, which may include cerebral palsy and epilepsy as well as other conditions except mental illness, such as autism, that result in impairments of general intellectual functioning or adaptive behavior and require early intervention services.
• In addition to the above required certification, a qualified professional who meets the criteria in 42 CFR 483.430(a) shall certify that the infant or toddler has impairments in adaptive behavior, which are likely to continue for at least 12 months, as documented by an assessment of adaptive functioning which shows one of the following:
  • Significant limitations in meeting the standards of maturation, learning, personal independence or social responsibility of the infant’s or toddler’s age and cultural group, as evidenced by a minimum of a 50% delay in one or a 33% delay in two of the following developmental areas: 
    • Cognitive development
    • Physical development
    • Including vision and hearing
    • Communication development
    • Social and emotional development
    • Adaptive development
• Substantial functional limitation in three or more of the following areas of major life activities: 
  • Self-care
  • Receptive and expressive language
  • Learning
  • Mobility
  • Self-direction
  • Capacity for independent living
  • Economic self-sufficiency

Wayne County Office of Behavioral and Developmental Programs and Early Intervention shall cooperate with the county assistance office in determining the initial and continuing financial eligibility of an infant or toddler with a disability and the infant or toddler’s family for waiver services.

Early Intervention Services

• Developmental services that meet the requirements of PA Code 4226 early Intervention Services:
• Are provided under public supervision
• Are provided at no cost to families
• Are designed to meet the developmental needs of an infant or toddler with a disability/delay and the needs of the family related to enhancing the infant or toddler’s development in one or more of the following areas:
  • Physical development, including vision and hearing
  • Cognitive development
  • Social or emotional development
  • Adaptive development
  • Are provided in conformity with an Individualized Family Support Plan
• Include, but are not limited to the following:
  • Family training, counseling and home visits
  • Special Instruction - teacher
  • Speech-language pathology services
  • Occupational therapy
  • Physical therapy
  • Psychological services
  • Service Coordination
  • Medical services only for diagnostic or evaluation purposes
  • Early identification and assessment services
  • Health services necessary to enable an infant or toddler with a disability to benefit from other early intervention services
  • Social work services
  • Vision services
  • Assistive technology devices and assistive technology services
  • Audiology services
  • Nursing services
  • Nutrition services

Personnel

All services are provided by qualified personnel, including, but not limited to, the following:

• Special educators
• Speech-language pathologists
• Occupational therapists
• Physical therapists
• Psychologists
• Social Workers
• Nurses
• Nutritionists
• Family therapists
• Orientation and mobility specialists
• Pediatricians and other physicians
• Early Interventionists
• Service coordinators
• Audiologists