Emerging Practice

Expanded eligibility for WV CYSHCN through enhanced screening

State/Jurisdiction: West Virginia
Setting: Clinical Community
Population: CYSHCN Families & Caregivers
Topic Area: Health Screening Care Coordination
NPMs: NPM 15: Adequate Insurance

Children and youth with special health care needs (CYSHCN) are defined as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” The West Virginia (WV) Children with Special Health Care Needs (CSHCN) Program’s diagnosis-based eligibility criteria were limited in scope and inconsistent with this consequence-based definition of CYSHCN. The WV CSHCN Program sought to develop new, more inclusive eligibility criteria that would allow the program to provide services to a greater number and broader range of CYSHCN. The WV CSHCN Program Screener calculates a child’s program eligibility status and intensity level using the child’s CYSHCN status, presence of a physical special health care need, acuity of functional limitations, service utilization, risk-based categorical eligibility criteria, and financial eligibility, as needed if Title V funding for medically necessary medical foods are required. The program has adopted a methodology including the five question CSHCN Screener©, additional questions from the National Survey of Children’s Health regarding functional limitations and service utilization, and program-specific eligibility criteria to determine a child’s eligibility status. First, children are identified by risk-based categorical eligibility (e.g., children in foster care, children diagnosed with neonatal abstinence syndrome). Then, the child’s special health care needs status is determined by the CSHCN Screener©. The CSHCN Screener© is a quick five question survey administered to parents/caregivers to identify if a child has a special health care need. Next, questions adapted from the National Survey of Children’s Health assess specific functional limitations and service utilization. Finally, financial eligibility for Title V funding for medically necessary medical foods is determined.

Back to Database