Service coordination is available for children with Medicaid Enhanced Benefits that have special healthcare needs. These special healthcare needs require medical and multidisciplinary habilitation or rehabilitation services to prevent or minimize a disability. If the child is unable to coordinate, maintain or access services on their own, or through other means, they might be eligible for service coordination services.
Service Coordinator functions are:
Plan Development & Assessment – A person centered planning process that identifies the person's need for assistance in gaining and coordinating access to needed medical, psychiatric, social, early intervention, education, and other services. The plan does not govern or manage community developmental disabilities services or any other services.
Referrals – Links the participant to needed medical, psychiatric, social, early intervention, education, and other services.
Monitoring – Monitors the plan to assure participant has been linked to needed services identified on the plan. The Service Coordinator will adjust the plan as necessary.
Crisis Assistance: Provides crisis assistance and may seek involvement of Department’s crisis prevention team.
Prior authorizations are required for ongoing service hours for new plans and plan renewals. Requests for Service Coordination must include the Assessment Form, Plan Form, Healthy Connection Referral Form, Agency Choice and Consent Form, and supporting medical documentation. All information necessary to make the eligibility determination for service coordination must be received 20 business days prior to the anticipated start date of any services. The eligibility determination must be made before any services are received.
Service coordination is also available through the Idaho Infant Toddler Program. Service coordination through the Infant Toddler Program is available to all qualifying children from birth through 36 months of age.
Please see the Children’s Developmental Disability Services webpage for more information about case management services available to children with developmental delay.
Service coordination for children with serious emotional disturbance (SED) is administered by a managed care contractor, Optum Idaho. Questions regarding eligibility, coverage, and services can be addressed by accessing the Optum Idaho website or calling their member number at (855) 202-0973.