Medically Fragile Children

A child is "medically fragile" if he or she has a chronic debilitating condition or conditions, and meets one or more of the following criteria: 

• is technologically dependent for life or health sustaining functions
• requires complex medication regimens or medical interventions to maintain or to improve their health status 
• is in need of ongoing assessment or intervention to prevent serious decline of health status or medical complications that put life, health, or development at risk

Chronic debilitating conditions include, but are not limited to: 

• bronchopulmonary dysplasia
• cerebral palsy
• congenital heart disease
• microcephaly
• pulmonary hypertension
• muscular dystrophy

A child requires a "Medically Fragile Level of Care" if he or she is under the age of 21 and:

• A licensed practitioner has, under state law, determined in writing that the child is at risk of institutionalization
• Written clinical documentation has been submitted to support this determination
• The child meets hospital or nursing facility admission criteria after a face-to-face assessement
• The child is eligible to receive LOC Home and Community Based Services (HCBS) and Community First Choice Option (CFCO) services if CFCO requirements are met

How Fidelis Care Can Help

Fidelis Care offers the Children's Health and Behavioral Health Program for Medicaid Managed Care members under the age of 21. This enhanced Medicaid Managed Care benefit package offers a wide range of children and family treatment support services and children’s home and community based services for qualifying members and their caregivers.