Children's Extensive Support (CES)
The Children's Extensive Support program (CES) provides Medicaid benefits to eligible children under the Medicaid State Plan (the Medicaid card) in addition to specific targeted services and supports. Services and supports provided through CES should increase the family's ability to maintain their child in the family home and prevent out-of-home placement. CES is targeted to a small group of children whose extensive level of behavioral and/or medical needs cannot be funded or supported through Family Support funding.
Along with the higher level of support and funding available through CES, there is a higher level of oversight and scrutiny as to how the funds are used to support the child in the family home. Although the CES program can provide supports tailored to individual family situations it is not intended to provide 24-hour services with CES as the only funding source. CES is designed to include a variety of other supports available to the child from other sources such as generic community supports, public school districts, Medicaid State Plan/EPSDT, or private insurance. CES is not intended to replace the family's responsibilities to provide for the typical needs of their child. CES is not able to provide all of the supports a child necessarily needs but is able to assist and supplement some of those needs.
CES Program Eligibility
To be eligible for the CES program the child must meet the following criteria:
- Determined to have a developmental disability or a developmental delay if younger than age five by a Community Center Board.
- Determination of eligibility for the CES program.
- The child is under the age of 18.
- The child lives with biological/adoptive parent or guardian or is in out-of-home placement and could return to the family home with CES supports.
- The child meets SSI requirements for disability determination.
- The quality and quantity of identified medical services or supports are provided with a doctor's order to meet the child's needs in the home.
- The income of the child cannot exceed 300% of the maximum SSI allowance.
- The child demonstrates a behavior or has a medical condition that requires direct human intervention at least once every two hours during the day and a weekly average of every three hours during the night.
- The behavior or medical condition must be considered beyond what is typically age appropriate and documented by a predetermined variety of records.
- The child must receive a waiver service once a month to maintain eligibility.
Eligibility does not necessarily guarantee the availability of funding. The child may be put on a statewide waiting list until funding becomes available.
Important CES Documents
CES Services & Supports
Includes childcare above and beyond that of the typical cost for any family, personal supports which require the direct involvement of another to ensure the physical needs are met (Must be beyond what Medicaid/EPSDT will pay for), and household services includes assistance in performing housekeeping tasks which are above and beyond that of a typical family because of the child's disability. Parents cannot be reimbursed for the provision of CES services to their child.
includes Home Modification, Assistive Technology, specialized medical equipment, adaptive Recreational Equipment, and evaluation and assessment. (Assessments are required to specify the need as related directly to the disability.) Must be in excess of what is available under Medicaid State Plan Benefits/EPSDT (A written Medicaid and/or private insurance denial may be required) and be directly related to the child's disability. There is a $10,000 cap through 6-30-09. All vitamins, food supplements, food items, medication FDA approved and Non-Approved, and Touch Therapy are excluded.
Specialized Medical Equipment
Specialized medical equipment is a device or items related directly to supporting the child in their home or community and are not otherwise available under Medicaid State Plan/EPSDT. The equipment is necessary due to the child's disabilities and is above and beyond the costs normally incurred by a family with a child without a disability. Items, which are not directly related to a direct remedial or medical need of the child, are excluded.
These are services that require the provider to be licensed or certified in a particular occupational skill area. Included are personal care functions, including operation of medical equipment, requiring professional care by licensed or certified medical care personnel. Behavioral services can be provided when challenging behaviors interfere with activities of daily living, social interaction, or other similar situations (The behaviors are above and beyond those of typical development for a child of similar age without disabilities).
These include services that explore community resources and services appropriate to the child, natural supports that are available, match and monitor community connections to enhance socialization and community access capability. Financial assistance, up to $500.00 a year, to participate in cost effective recreational or community activities that will allow the child with the developmental disability to experience typical leisure time activities to develop appropriate physical and psychological-social skills. Excluded activities include tickets for movies, theater, concerts, and professional and minor league sporting events. Family members living in the same household cannot be paid to provide these supports.