A program for Medically Complex Children in Foster Care General Overview: MassHealth and the Department of Children and Families (DCF) co-sponsor a medical program for children in foster care who have special health care needs. Special KidsSpecial Care provides intensive medical case management for children with complex medical needs who are in DCF custody and in foster care. MassHealth contracts with Neighborhood Health Plan (NHP) to provide the medical case management. The child must need complex medical management on a regular basis and skilled nursing care on a regular basis; or skilled assessment or monitoring for an unstable medical condition on a regular basis. The clinical team at MassHealth reviews recent medical records to determine whether the child is medically appropriate for the program.
A child must be in DCF custody and in foster care (some group care settings are allowed) when initially enrolled. If a child is subsequently adopted, under guardianship or returns to the biological parents, the child can remain in the program as long as they are medically appropriate and the case is open with DCF.
Medical Case Management Provided:
Once a child is enrolled, a pediatric nurse practitioner (PNP) from NHP works with DCF staff, the foster family and the primary care physician to develop a detailed Individualized Healthcare Plan and arrange for the child to obtain all necessary medical care and services.
The Individualized Healthcare Plan is updated quarterly and provided to the DCF social worker, social workers from contracted agencies, if any, and the foster parent(s).
The PNP makes home visits and assesses the child’s medical needs on an ongoing basis.
The PNP assesses the child’s need for additional specialty care, services and equipment and orders and arranges for whatever is necessary. The MassHealth prior approval process that is required for some medical equipment and services is not required.
The primary care physician and PNP work closely with the child’s DCF social worker and foster family to provide management and monitoring of the child’s healthcare needs 24 hours a day, 7 days a week.
The PNP works collaboratively with school nurses and other community and state agencies to coordinate and facilitate all services and resources that are available and beneficial to the child.
The PNP works with the DCF staff and foster parents to assess potential respite placements and ensure that the respite placement has all necessary medical services and equipment.
For children transitioning to adoption, guardianship or biological parents, the PNP coordinates medical services, assists DCF in assessing the parents’ ability to care for the child and visits the prospective home to determine its appropriateness for meeting the child’s medical needs.
Examples of some of the medical conditions of children currently enrolled are: Uncontrolled Diabetes, congenital anomalies, liver disease, Prematurity, Spastic Quadraparesis, Encephalopathy, neurological disorders, Cystic Fibrosis, AIDS, Renal Failure, Cancer and Cerebral Palsy. The program serves children from newborn to 22 years of age.