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The Children with Serious Emotional Disorder Waiver (CSEDW) is a Medicaid HCBS Waiver program authorized under the Social Security Act. The CSEDW provides services that are additions to Medicaid State Plan coverage for CSED who are enrolled in the CSEDW program, from age 3 up to the youth’s 21st birthday. The CSEDW permits WV to provide an array of HCBS that enables children who would otherwise require institutionalization to remain in their homes and communities. In addition, it is anticipated that this waiver will reduce the number of children housed both in-state and out-of-state in Psychiatric Residential Treatment Facilities (PRTFs) and shorten the lengths of stay for children who require acute care.
WV defines the term “children with a serious emotional disorder” (CSED) as children with an SED who are age 3 to age 21 and who currently or at any time during the past year have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders (DSM) (or International Classification of Disease (ICD) equivalent) that is current at the date of evaluation that results in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, and/or community activities.
The Bureau for Medical Services (BMS), within the WV Department of Health and Human Resources (DHHR), is the single state agency responsible for statewide administration of the Title XIX Medicaid Program. BMS operates the CSEDW in conjunction with the specialized managed care program for children and youth (1915(b) waiver). As appropriate, Medicaid members receiving services under the CSEDW may receive any of the Medicaid State Plan services and waiver services identified in Appendix C of this §1915(c) HCBS Waiver application. Members enrolled in the CSEDW may not be enrolled simultaneously in another WV §1915(c) waiver. Members are permitted to receive services on the CSEDW while on a waitlist for another 1915(c)waiver.
WV Medicaid authority under the direction of the WV DHHR will contract with an Administrative Service Organization (ASO) and psychological practice as the Medical Eligibility Contracted Agent (MECA) to address program eligibility and enrollment. Medicaid managed care entities will be responsible for utilization management. The WV Medicaid Management Information System (WVMMIS) contractor will be responsible for enrollment of providers who then must contract with the Managed Care Organization (MCO) to be providers for the CSEDW.
Rachel Goff, MBA
Program Manager: Children with Serious Emotional Disorder Waiver