Special Needs Children
On February 1, 2020, The Illinois Department of Healthcare and Family Services (HFS) worked with Managed Care Organizations to transition 21,800 fee-for-service Special Needs Children (SNC) into managed care.
Special Needs Children Include:
- Children receiving Supplemental Security Income (SSI)
- Children enrolled in the Division of Specialized Care for Children (DSCC) CORE program
- Children with a physical disability category
Excluded from this population:
- Medically Fragile Technology Dependent (MFTD) waiver members
- Nursing and Personal Care Services Program (NPCS)
- Currently has commercial insurance
Our goal is to increase effective communication between, families, providers, and MeridianTotal to ensure the best health outcomes are achieved and care gaps are decreased. The overall objective is to help manage the wellness of these children resulting in them moving to a personal optimal health status. MeridianTotal has been proactively identifying interventions based on the needs of this specialized population.
Provider Call to Action
In order to provide the most effective care of these members, MeridianTotal implores providers to:
- Work with our Specialized Care Coordination Team
- MeridianTotal has created a team of licensed clinicians who are subject matter experts, with extensive knowledge of physical, behavioral and social supports needed by special needs children. However, provider input is invaluable.
- Review status as Extended Provider Network
- Providers contracted for MeridianTotal are also contracted with SNC. If there are any questions regarding network status, please call Member Services, 877-941-0482, for contract verification.
- MeridianTotal will also honor the 180-day continuity of care mandate by HFS
- Any treatment plan services established before 2/1/2020 will be honored by MeridianTotal. Providers should honor the continuity of care for all procedures, appointments and additional services.
Special Needs Children FAQs
Currently Special Needs Children identification is not available in the Medi system. MeridianTotal has raised this issue to HFS for follow-up. Until the issue is resolved please:
- Call MeridianTotal's Member Services team to verify eligibility 877-941-0482.
- Visit the MeridianTotal Provider portal which is being updated to hold an SNC identifier.
- Be informed that MeridianTotal Special Needs Children will be receiving specialized member identification cards.
- Yes, children who are enrolled in MFTD and who receive NPCS will continue to be excluded from Managed Care.
- No, these are not the same population. However, all providers contracted for YouthCare are contracted for Special Needs Children as well.
- YouthCare are children with some type of DCFS involvement.
- Special Needs Children are identified based off of health needs.
- Providers contracted for YouthCare are also contracted with SNC. If there are any questions regarding network status, please call Member Services at 877-941-0482 for contract verification. You can also visit our Find a Provider page and download the Provider Directory here to confirm if you are in the network.
- Please submit a prior authorization in the comments, and please identify the member as Special Needs, if possible. If there are any issues with a continuity of care service, please escalate it directly to the Special Needs Children Care Management Team by calling Member Services and requesting a leader on the Special Needs Children Team.
- Special Needs Children will receive all their Medicaid covered services and medical care coordination from the health plan.
Thank you for your ongoing commitment to these children as well as your patience during the transitions.
If there are any escalated needs, please request to speak with one of the SNC leadership team members or your MeridianTotal Provider Relations Representative.