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Fund Your AT > Medically Necessary > Infants & Children

Funding for Medically Necessary AT for Infants & Children

Help Accessing Services

Care Coordination for Children with Special Health Care Needs

Is available through the Massachusetts Department of Public Health (MDPH) to help families with the difficult task of navigating health services. Read more.

Care coordination services are available through the Massachusetts Department of Public Health (MDPH) for children with special health care needs. Care Coordinators can help families, educators, and service providers learn about publicly funded services ("entitlements") and how to access them, how to find appropriate community-based resources, how to best advocate for a family's needs, and how to connect with other families who face similar challenges for support. Individualized services are available as well as trainings for groups and agency staff. The program is designed to help families who are experiencing difficulty getting or keeping health services for their child with special needs, and to help service providers who need information/technical assistance about services for children and adolescents with special health care needs.

DPH Care Coordinators work as part of the MA Medical Home Project. Care Coordinators are located in pediatric medical practices throughout Massachusetts.

Learn more at the MDPH Care Coordination website

Contact:

To find the Care Coordinator appropriate for you, contact the MDPH's Community Support Line for Children with Special Health Care Needs: (800) 882-1435

Sandra Broughton, Director
Bureau of Family Health and Nutrition
250 Washington Street
Boston, MA 02108
Telephone: (617) 994-9819
Fax: (617) 624-5990
Email: sandra.broughton@state.ma.us

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Case Management

May be available from your private health insurance provider to help coordinate your child's care. Read more.

Some private health insurance providers provide case management or "care management" services to help families access and coordinate services and benefits. A case manager (usually a nurse or social worker) can work with you to:

  • Assess your child's health care needs
  • Plan and coordinate your child's health care with your child's primary care provider (doctor)
  • Communicate with health care providers
  • Find resources and services
  • Improve your child's overall care

See: Directions: Resources for Your Child's Care, Chapter 7, "Your Child's Health Plan" available at this MDPH web page .

Contact:

A Member Services Representative at your child's health plan to learn if case management services are available.

Early Intervention

Provides services to support the development of infants and toddlers from birth to age 3 (MDPH). Read more.

The Early Intervention (EI) program of the Massachusetts Department of Public Health (MDPH) provides developmental services to children from birth to age three. Children served by the program have developmental challenges due to disabilities, or they are at risk for developmental challenges because of environmental factors or a difficult birth. EI provides an assessment and works with the family to make a plan for services and supports to best meet the child and family's needs. The plan-called an Individualized Family Service Plan or IFSP-may include assistive technology.

EI services are paid for by public and private health insurance. Families do not bear the cost of insurance co-payments or deductibles, although some families pay an annual fee that is based on family size and income.

Who is Eligible?

Any child up to age 3 who is:

  • not reaching age-appropriate milestones in one or more areas of development,
  • diagnosed with a condition (physical, emotional, cognitive) that may result in a developmental delay,
  • at risk for developmental delay because of various biological and/or environmental reasons.

What Services are Provided?

AT is considered a "specialty service." Children with hearing loss, vision loss, deaf/blindness, complex medical needs, multiple disabilities, or an Autism Spectrum Disorder are provided with specialty services in addition to standard EI services. Standard EI services can include home visits and therapies, community child groups, parent groups, and transportation to and from services.

How are Services Provided?

An EI team made up of professionals from different disciplines along with family members work with the child in the home or another community-based "natural" environment (day care center, play group, etc.) Depending on the child's needs, this team may include an educator, physical therapist, speech-language pathologist, occupational therapist, psychologist, nurse, etc. as well as the child's medical provider.

Learn more at the MDPH EI website.

Contact:

(800) 905-8437
Ask for a listing of certified Early Intervention Programs serving your city or town.

Or visit www.massfamilyties.org

Click on "EI Directory" for a listing of certified Early Intervention programs. You should contact your local program directly to make a referral. Note: anyone can call and make a referral; there is no prior approval necessary from a health plan.

Ron Benham, Director, Early Intervention Program
Bureau of Family Health and Nutrition
250 Washington Street
Boston, MA 02108
(617) 624-5901 Voice
(617) 624-5990 FAX
(617) 624-5992 TTY
Email: Ron.Benham@state.ma.us
Division of Perinatal, Early Childhood, and Special Health Needs

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Universal Newborn Hearing Screening

Identifies newborn hearing problems and links families with appropriate services. Read more.

This Massachusetts Department of Public Health (MDPH) program ensures that all newborns are provided with a hearing screening prior to hospital or birth center discharge, and that babies and families are referred for appropriate follow-up services - which may include AT. Most follow-up services are provided by referral to the Early Intervention (EI) program. The Universal Newborn Hearing Screening program is another point of access to EI.

In general, 1 in 1,000 newborns have some kind of hearing loss and those who receive services before six months of age have better language, speech and social skills than those whose hearing loss is identified later.

Who is Eligible?

All infants born in Massachusetts are required to be provided a hearing screening prior to discharge from a hospital or birthing center, as mandated by Chapter 243 of the Acts of 1998. Public and private health insurance providers pay for the cost of the test. Infants who fail the test are referred for follow-up services.

What Services are Provided?

  • family support, including parent-to-parent support
  • outreach and education,
  • information about and referral to available resources, including Early Intervention, and the MDPH Hearing Aid Program,
  • technical assistance to families, birth facilities, and hearing testing centers.

How are Services Provided?

Newborns are screened using a machine that they may not even be aware of and many sleep through the test. Babies who fail the test are referred for follow-up testing at an MDPH audiological diagnostic center. Some pass follow up testing and some fail.

The Universal Newborn Hearing Screening Program has developed a kit for parents whose child has been diagnosed with a hearing loss. Some of the materials are available online at this Universal Newborn Hearing Screening MDPH web page . Or to request a complete kit:

Contact:

Janet Farrell, Director
Universal Newborn Hearing Screening
Bureau of Family Health and Nutrition
250 Washington Street
Boston, MA 02108
(800) 882-1435 or (617) 624-5959
(617) 994-9822 Fax
(617) 624-5992 TTY
Email newborn.hearing@state.ma.us
www.mass.gov/dph

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Funding Sources

MassHealth (Medicaid)

Federal and state funded health insurance for very low to medium income people living in Massachusetts is available through the various programs of MassHealth. MassHealth can provide health care benefits directly or pay all or part of an individual or family's health-insurance premium.

MassHealth Standard

Includes coverage for children under age 19; income restrictions vary (up to 150-200% of the federal poverty level). DME is covered. Read more.

MassHealth CommonHealth

Includes coverage for children with disabilities who are over-income for MassHealth Standard and have no private insurance. There is no upper-income limit or asset test. Premiums are determined on a sliding scale. DME is covered. Read more.

MassHealth Family Assistance

Provides income-eligible children (up to 200% of the federal poverty level) who cannot get MassHealth Standard or MassHealth CommonHealth with access to either private or public health insurance. DME coverage varies by plan. Read more.

Children's Medical Security Plan (CMSP)

CMSP provides state-funded coverage to uninsured income-eligible children. Hearing tests, eye exams, and DME up to $200 per fiscal year (plus an additional $300 per year for DME related to certain conditions) are covered. Read more.

This is state-funded health insurance coverage for uninsured children and adolescents whose family incomes are too high to qualify for MassHealth (except MassHealth Limited). Families pay premiums and co-pays based on their income and family size. There is no asset test. The program focuses on primary and preventive care and sometimes carries a waiting list. Limited DME coverage is provided. The program is administered by MassHealth.

Who is Eligible?

Children under the age of 19 who are Massachusetts residents. There is no upper income cap for the program (premiums and co-pays go up with income). MassHealth does not charge any CMSP premium for children who have a parent or guardian enrolled in and paying a premium for a Commonwealth Care health-insurance plan.

What DME Services are Provided?

  • hearing tests
  • eye exams
  • specialty consultations, and
  • DME up to $200 per state fiscal year, with an additional $300 per state fiscal year for equipment and supplies related to asthma, diabetes, and seizure disorders

What DME Services are NOT Provided?

In addition to the limit on DME expenses, medical transportation services are not covered, and Early Intervention services are not covered by CMSP (however, the Department of Public Health pays for EI services not covered by insurance).

How are DME Services Provided?

No prior authorization (prior approval) is necessary to access the limited DME equipment/services covered by this insurance. You will need to get a prescription for the DME from your primary care provider and the plan will pay the DME supplier up to the coverage limit for that year.

Contact:

MassHealth

CMSP website

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Medicare

Children with end-stage renal disease are eligible for this federal health insurance program. Some DME is covered under "home health" through Medicare Part A, and more DME benefits are available under the optional Part B coverage. Read more.

Catastrophic Illness in Children Relief Fund (CICRF)

The CICRF was established to help families bear the excessive financial burdens associated with the care of children with special health care needs and disabilities. Medically related home and vehicle modifications, medical transportation, and medical equipment are among the categories of expenses eligible for reimbursement. Read more.

The CICRF was established to help families bear the excessive financial burdens associated with the care of children with special health care needs and disabilities. The Fund reimburses families for expenses they've already paid for or assumed debt to cover. The expenses must not be coverable by insurance. The Fund works on a reimbursement basis only, except in cases of extreme emergency. In all cases, the CICRF should be considered the "payer of last resort" after the family makes all reasonable attempts to pursue other funding.

Who is Eligible?

Applicants must be residents of Massachusetts, 21 years of age or younger, and under the care of a licensed health care provider with staff privileges at a hospital licensed or accredited to provide pediatric or neonatal care.

In addition, the family of the applicant must have expenses related to the medical condition that are considered "excessive." The CICRF has a formula for determining this standard (for example, if a family earns less than $100,000 per year, the medical expenses must be a minimum of 10% of the family's gross annual income). Expenses eligible for consideration must have incurred within 24 months of the application date.

What AT Services are Eligible?

Medically related home and vehicle modifications, medical transportation, and medical equipment are among the categories of expenses eligible for reimbursement (if they are found to be reasonable). Read the complete list of eligible medical expense categories at the CICRF website.

Only expenses for which the family is directly responsible as a result of the child's medical condition may be considered for payment or reimbursement. For example, expenses covered by health or other insurance cannot be included in the calculation of total eligible expenses.

Contact:

The CICRF website
(800) 882-1435
(617) 624-5992 TTY

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Hearing Aid Program for Children (MDPH)

This program at the Massachusetts Department of Public Health can help income-eligible families (whose health insurance won't cover the expense) afford a hearing aid. Read more.