For children (under age 21), states must provide a Medicaid benefit known as Early & Periodic Screening, Diagnosis & Treatment (EPSDT). In essence, if a service is medically necessary to correct or ameliorate a child’s diagnosed condition, it should be provided. This includes personal care and private duty nursing services, as well as other home care like therapies, consumable medical supplies, and behavioral services.

Be aware that when a child turns 21, they are no longer subject to EPSDT and will not be able to access HCBS through basic Medicaid. Before that happens, it is critical to seek enrollment in a HCBS Waiver program.

In Florida, most people get basic Medicaid through managed care, where private entities (usually insurance companies) act as the gatekeepers for services and providers. Many children who require HCBS are medically fragile and are under a specialty managed care plan called Children’s Medical Service.

The iBudget Waiver is available to children age 3 and up who have a developmental disability, although like all HCBS Waivers, enrollment is capped and in Florida there is a long waiting list. See iBudget Waiver for more information.

To complicate matters, when a child is enrolled iBudget, they are generally automatically enrolled in basic Medicaid as well. This is because once a child is enrolled on an HCBS Waiver, eligibility for basic Medicaid is based only on the child’s income rather than parental income. Since HCBS Waivers are the “payers of last resort,” children on iBudget must seek HCBS services offered through basic Medicaid if iBudget offers similar services.

The Long-Term Care Waiver is for ages 18 and up with a disability and needing a nursing home level of care. While not technically for “children,” if a medically fragile child on basic Medicaid is not on the iBudget Waiver and will be losing all HCBS when they turn 21, they can transition to the LTC Waiver skipping over the waiting list.

Familial Dysautonomia Waiver is for ages 3 and up with a diagnosis of familial dysautonomia and needing a hospital level of care.

Model Waiver is for ages 20 and younger, disabled, at risk of hospitalization and either diagnosed with degenerative spinocerebellar disease OR deemed medically fragile and residing in a skilled nursing facility for at least 60 consecutive days prior to enrollment.