How to get help for a medically complex child in SC

52 Medically Complex

For parents and guardians with medically complex children, there are many challenges and hurdles to overcome to ensure their child receives the best care and resources available. Medically complex children are defined as children who have chronic complex medical conditions that require ongoing care by several pediatric specialists and who may need specialized medical equipment.

Medically complex children may have conditions that involve multiple organ systems, require the use of technology to sustain life, use a wheelchair, braces, lifts or other special equipment, use more medical services than the average child such as medical daycare, private nursing, and rehabilitative therapy, or receive care in a medical foster home. Complex conditions include chronic lung disease, cerebral palsy, chronic respiratory failure requiring ventilator support, complex congenital heart defects; genetic disorders; or severe epilepsy.

The Medically Complex Children’s Waiver is a statewide program from the South Carolina Department of Health and Human Services (SCDHHS) that serves Medicaid eligible children under the age of 18 who meet certain level-of-care and medical criteria. Services available through the Waiver include Care Coordination, Incontinence Supplies, Pediatric Medical Day Care (upstate only), private duty nursing and children’s personal care aide services. The goal of the waiver is to decrease hospital/ER admits and provide a better quality of life for the child at home. Nurse Care Coordinators working through an organization called South Carolina Solutions provide a link between waiver participants and all of their medical and community service providers.

To be eligible for Medically Complex Children’s Waiver screening, a child must be:

  • Age 0-17
  • Have active SC Medicaid insurance
  • A resident of SC

To determine if a child is medically complex, the child would need to be screened with a Medical Eligibility Assessment and a Level of Care Assessment by an RN. If found eligible, the program offers three State Medicaid Plan Services that include the following:

  • Children’s Personal Care Aid Service
  • Children’s Private Duty Nursing
  • Incontinence Supplies (must be age 4 and incontinent)

The program also offers two Waiver services that include Care Coordination by a Registered Nurse every month, and Skilled Pediatric Day Care Service (Upstate only).

In the program, an RN sees the child every 3 months face-to-face and will complete a monthly call to the child on the non-face-to-face months updating a Care Plan that is shared with the child’s pediatrician. The RN will also assist and advocate for any needs the child may have and act as a liaison for state and community services/resources. All RNs have pediatric experience, some including certifications such as: Certified Pediatric Nurse (CPN) and Certified Case Manager (CCM).

To make a referral to the Medically Complex Children's Waiver, visit https://phoenix.scdhhs.gov/cltc_referrals/new.

For more information on medically complex providers and services or to report abuse/fraud, visit https://sc-solutions.org/


By ABC Quality Team at 30 Jun 2020, 00:00 AM