Children with Serious Emotional Disturbances Waiver

 

Waiver for Children with Serious Emotional Disturbance (SEDW)

The Michigan Department of Health and Human Services (MDHHS) received approval from the Centers for Medicare and Medicaid Services (CMS) for the Children's Home and Community-Based Services Waiver for Children with Serious Emotional Disturbance (SEDW), which began in October 2005, in a limited number of counties.  Effective October 2019 CMS approved MDHHS to expand the SEDW to all counties in the state of Michigan.

The Children's SEDW provides services that are enhancements or additions to Medicaid State Plan coverage for children through age 20 with SED. The MDHHS operates the SEDW through contracts with the Prepaid Inpatient Health Plans (PIHPs).  The SEDW is a managed care program administered by the PIHPs in partnership with Community Mental Health Service Providers (CMHSPs) and other community agencies.  

Key Provisions

The SEDW enables Medicaid to fund necessary home and community-based services for children with serious emotional disturbance who meet the criteria for admission to the state inpatient psychiatric hospital (Hawthorn Center) and/or are at risk of hospitalization without waiver services. The CMHSP is responsible for assessment of potential waiver candidates.

Application for the SEDW is made through the CMHSP.  The Wraparound Facilitator, the child and his/her family and friends, and other professional members of the planning team work together to identify the child/family's strengths, needs, interventions and outcomes following the Wraparound Practice Model.  The Wraparound Individual Plan of Service (IPOS) identifies all the services and supports necessary to meet the needs and outcomes.

Eligibility

To be eligible for this waiver, the child must:

•     Reside with the birth or adoptive family or have a plan to return to the birth or adoptive home; OR

•     Reside with a legal guardian; OR

•     Reside in a foster home with a permanency plan; OR

•     Be age 18, 19 or 20 and live independently with supports; AND

•     Meet current MDHHS criteria for the State psychiatric hospital for children, as defined in the Michigan Medicaid Provider Manual, and/or who are at risk of hospitalization without waiver services; AND

•     Meet Medicaid eligibility criteria and become a Medicaid beneficiary; AND

•     Demonstrate serious functional limitations that impair their ability to function in the community.  As appropriate for age,  functional limitation will be identified using the Child and Adolescent Functional Assessment Scale (CAFAS®), the Preschool and Early Childhood Functional Assessment Scale (PECFAS®), or the Devereaux Early Childhood Assessment (DECA®) Clinical Version scales: 

o   CAFAS® score of 90 or greater for children age 7 to 12; OR

o   CAFAS® score of 120 or greater for children age 13 to 18; OR

o   For children age 3 to 6: elevated PECFAS® subscale scores in at least one of these areas: self-harmful behaviors, mood/emotions, thinking/communicating or behavior towards others; 

o   For children ages 2 to 4, scores in the concern range across DECA clinical version scales:

  • Protective factor scales (initiative, self-control and attachment) that are in the Concern Range with a Total Protective Factor T-score of 40 or below and/or
  • Elevated scores on one or more of the behavioral concerns 32 scales (attention problems, aggression, withdrawal/depression, emotional control problems) with a T-score of 60 or above; AND

•    Be under the age of 18 when approved for the waiver.  If a child on the SEDW turns 18, continues to meet all non-age-related eligibility criteria and continues to need waiver services, the child can remain on the waiver up to his/her 21st birthday.

 

If you suspect or are aware of the abuse, neglect or exploitation of a recipient of public mental health services in Michigan, use the following link to assist you in reporting the information, or call the MDCH-ORR

Hotline:             1-800-854-9090.

http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4901---,00.html.

Contact:

Angelo Powell, Waiver Specialist e-mail:  powella8@michigan.gov,

517-241-9069