April 11, 2006

 

 

 

 

 

TO:                  Idaho Medicaid Providers

 

FROM:            Leslie M. Clement, Deputy Administrator

 

SUBJECT:       Clarification of Medicaid Coverage for Children

 

 

The purpose of this Information Release is to clarify coverage requirements for children under the Early & Periodic Screening, Diagnosis, and Treatment program.  As you are aware, Medicaid is required to cover most medically necessary services for conditions discovered during a well-child exam. 

 

However, this requirement does not extend to covering services that Medicaid provides only to adults under a Home and Community-based waiver program.  Therefore, home modifications and specialized equipment for the home (for example, wheelchair lifts) are not covered items for children under Idaho Medicaid’s current structure.  This holds true even if there is a physician’s statement of medical necessity.

 

If you have any questions concerning the information contained in this release, please contact Ms. Robin Pewtress, Policy Specialist for the Bureau of Medical Care, at (208) 364-1892.

 

Thank you for your continued participation in the Idaho Medicaid Program.

 

LC/rp