Help Accessing Services
Care Coordination for Children with Special Health Care Needs
The Massachusetts Department of Public Health (MDPH) provides care coordination services to help families navigate the complexities of the health care system for children with special health care needs.
Care Coordinators assist families in accessing publicly funded services (entitlements) and community-based resources. They also offer guidance on advocacy, helping families secure the support their child needs. Additionally, they connect parents with others facing similar challenges, fostering a network of peer support.
These services are available on an individual basis as well as through trainings for groups and agency staff. The program is specifically designed for families struggling to secure or maintain essential health services for their child. It also provides technical assistance and information to service providers working with children and adolescents who have special medical needs.
MDPH Care Coordinators are part of the Massachusetts Medical Home Project and are located in pediatric medical practices across the state
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
Case Management Services
Some private health insurance providers offer case management or care management services to assist families in coordinating their child’s health care needs. These services help streamline access to benefits and medical resources, ensuring more effective care.
A case manager, typically a nurse or social worker, can assist with:
- Evaluating your child’s specific health care needs
- Coordinating medical care with their primary care provider
- Communicating with health care professionals
- Identifying available resources and services
- Enhancing the overall quality of care for your child
- Availability varies by insurance provider, so check with your plan to see if case management services are offered.
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 Services
The Early Intervention (EI) program under the Massachusetts Department of Public Health (MDPH) provides developmental support for infants and toddlers from birth to age three. It serves children facing developmental challenges due to disabilities or those considered at risk because of environmental factors or birth complications.
EI begins with a comprehensive assessment, followed by the creation of an Individualized Family Service Plan (IFSP) tailored to the child’s specific needs. If necessary, the plan may include assistive technology to aid in development.
Who Is Eligible?
A child under three years old may qualify if they:
- Are not reaching age-appropriate developmental milestones
- Have a diagnosed condition (physical, emotional, cognitive) that could lead to delays
- Are at risk of developmental delays due to biological or environmental factors
What Services Are Provided?
Assistive technology is classified as a specialty service within EI. Children with hearing or vision impairments, deaf-blindness, complex medical needs, multiple disabilities, or Autism Spectrum Disorder receive specialty services in addition to standard EI services.
Standard EI services may include:
- Home visits and therapy sessions
- Parent support groups and community-based child groups
- Transportation assistance for accessing services
How Are Services Provided?
A multidisciplinary EI team works directly with the child and their family. This team may include:
- Educators
- Physical and occupational therapists
- Speech-language pathologists
- Psychologists and nurses
- Medical providers
Services are delivered at home or in natural community settings (such as daycare centers or playgroups) to ensure a familiar and supportive learning environment.
Cost of Services
EI services are covered by public and private health insurance, and families do not pay co-pays or deductibles. However, some families may have an annual fee, which is based on household size and income.
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
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
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)
The Children’s Medical Security Plan (CMSP) is a state-funded health insurance program designed for uninsured children and adolescents in Massachusetts whose family incomes exceed the eligibility threshold for MassHealth (excluding MassHealth Limited).
The program focuses on primary and preventive care, with limited coverage for durable medical equipment (DME). Families enrolled in CMSP pay premiums and co-pays based on income and family size, but there is no asset test. CMSP is administered by MassHealth and may have a waiting list due to funding limitations.
Who Is Eligible?
To qualify, a child must:
- Be under 19 years old
- Be a Massachusetts resident
- Have no upper income cap (however, premiums and co-pays increase with income)
Additionally, MassHealth waives CMSP premiums for children whose parent or guardian is enrolled in and paying for a Commonwealth Care health insurance plan.
What DME Services Are Provided?
The program covers:
- Hearing tests
- Eye exams
- Specialty consultations
DME coverage up to $200 per fiscal year, with an additional $300 per fiscal year for DME related to asthma, diabetes, and seizure disorders
What DME Services Are NOT Provided?
CMSP does not cover:
- Medical transportation services
- Early Intervention (EI) services (though EI services not covered by insurance may be funded by the Department of Public Health)
How Are DME Services Provided?
- No prior authorization is required for DME services covered under CMSP.
- A prescription from the child’s primary care provider is necessary.
- The plan pays the DME supplier directly, up to the annual coverage limit.
Contact:
Medicare
Children diagnosed with end-stage renal disease (ESRD) qualify for Medicare, a federal health insurance program. Certain durable medical equipment (DME) is covered under Medicare Part A when provided through home health services, while additional DME benefits are available through the optional Part B coverage.
Catastrophic Illness in Children Relief Fund (CICRF)
The CICRF was created to help families manage the financial strain of caring for children with severe medical conditions and disabilities. It reimburses families for expenses they have already paid or taken on debt to cover, provided those costs are not covered by insurance. The fund operates strictly on a reimbursement basis, except in extreme emergencies, and always serves as the last-resort payer after families have exhausted all other available funding sources.
Eligibility
The program is available to Massachusetts residents under 21 who receive care from a licensed health care provider affiliated with a hospital accredited for pediatric or neonatal care. Financial eligibility is determined by the family’s medical expenses in proportion to their income. For instance, a family earning under $100,000 per year must have medical expenses equal to at least 10% of their gross income. Only expenses incurred within the past 24 months qualify for reimbursement.
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
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.