Service Coordination: Participant Eligibility

01. Adults. A DD diagnosis and a need for assistance to access service and supports necessary to maintain their independence. (7-1-26) 02. Children. All information necessary to make an eligibility determination must be received by the Department twenty (20) business days prior to the anticipated service coordination start date. The Department determines eligibility based on information provided by the service coordination agency or the family prior to the initiation of initial and ongoing plan development and services. Participants must meet the following requirements: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 632 Page 153 a. Age of thirty-seven (37) months through the month of their 21st birthday. (7-1-26) b. A diagnosis with special health care needs requiring medical and multidisciplinary rehabilitation services identified by a medical provider to prevent or minimize disability. (7-1-26) c. Reimbursement for services is not available for participants whose needs can be met by other paid or unpaid sources. The child must require service coordination for one (1) or more of the following: (7-1-26) i. A condition resulting in functioning below normal age level in one (1) or more life areas; (7-1-26) ii. At risk of placement in a more restrictive environment or returning a child from an out of home placement due to their condition; (7-1-26) iii. Danger to the health or safety of the child exists or a parent is unable to meet the child’s needs; (7-1-26) iv. Further complications may occur due to the condition without service coordination; or (7-1-26) v. Requires multiple service providers and treatments. (7-1-26)