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SED waivers provide additional services to Medicaid State Plan coverage for youth with a Serious Emotional Disturbance (SED).
The Michigan Department of Health and Human Services (MDHHS) provides community-based services to enable youth who would otherwise require hospitalization to remain in home and community settings, and who would otherwise not be eligible for Medicaid-funded supports.
The youth and family must live in a community-based setting (not in a hospital, ICF/IID, nursing facility, correctional facility, or child caring institution) while receiving services. Other criteria include:
SED screening tools used by OCHN include:
- Child and Adolescent Functional Assessment Scale (CAFAS®)
- Preschool and Early Childhood Functional Assessment Scale (PECFAS®)
Children aged 3 to 7, elevated subscale scores (20 is considered an elevated subscale score) in at least one of these areas:
- Devereux Early Childhood Assessment Scales (DECA)
Children aged 2 to 4, scores in the concern range across Protective factor scales (initiative, self-control, and attachment):
The MDHHS operates and provides oversight of the SEDW through contracts with the Regional Prepaid Inpatient Health Plans (PIHP).
Application for the SEDW is made through the PIHP/ OCHN, Access department. The SEDW is intended to be short-term (1 year). Individuals who meet all eligibility criteria are submitted to MDHHS for approval. An annual recertification process to assure ongoing eligibility is required.
Once approved, the PIHP/OCHN is responsible for the oversight of SEDW service coordination. Youth will receive services and coordination of services from a Core Provider Agency contracted with OCHN to receive Wrap-Around and any other medically necessary service consistent with the Medicaid Provider Manual.
The Wraparound Facilitator, the youth and their family and friends, and other professional members of the planning team identify the youth’s needs and secure necessary services. All services/supports must be included in an Individual Plan of Services (IPOS).
If a youth on the SEDW turns 18, meets all non-age-related eligibility criteria, and continues to need waiver services, they can remain on the waiver up to their 21st birthday. Participants must receive at least one SEDW service per month in addition to Wraparound contacts to retain eligibility.