Does my child need to be in a care facility or receiving treatment outside of West Virginia?

No, your child does not need to be in a care facility or receiving treatment outside of West Virginia to qualify. However, priority is given to children or youth with serious emotional disorders (SED) who are:

a. Currently in psychiatric residential treatment facilities (PRTFs) or other residential treatment centers, whether located in-state or out-of-state.

b. Eligible for Medicaid and at risk of being placed in a medical care facility.

Yes, you can apply for CSEDW services even if you're on another waiver waitlist. However, please note that you cannot participate in multiple waivers simultaneously. If your child is eligible for services under both programs, the CSEDW services must specifically benefit them.

No, you cannot use an independent psychological report directly for the CSEDW application. The evaluation must be conducted by a healthcare provider approved by the Medical Eligibility Contracted Agent (MECA), using specific tools and tests required by CSEDW. However, it would be helpful to provide your independent evaluator with a copy of the recent report and other important medical records.

If your child already has a therapist who is not enrolled as a CSEDW provider, there is a process in place developed by the Bureau for Medical Services (BMS) and Aetna Better Health of West Virginia. This process allows your child to continue receiving therapy through the Medicaid State Plan. Once a strong therapeutic relationship is established, your child's team will collaborate with Aetna’s care manager to complete a Coordination of Care Agreement. This agreement will include the agency providing other CSEDW services and confirm the primary caregiver’s preference for this option. In-home family therapy for your child will not be billed under the CSEDW program, and assistance with the Wellness Recovery Action Plan (WRAP) must adhere to standard policies and procedures.

Eligibility, both medical and financial, must be re-established annually. However, this waiver is not intended for long-term services. The duration of the waiver is based on the individual needs of the child, with an average length of six to nine months.

No, the CSEDW program does not maintain an exact list of SED diagnoses that qualify.

The referral process is designed to be completed within 45 days from the initial referral to the final decision.

If your child is determined not medically eligible, you (or your child’s legal representative) will receive a written Notice of Decision. This notice includes forms to request a second medical examination, appeal the decision through the Medicaid Fair Hearing process, and access legal help. If you wish to appeal, you must submit the Request for Hearing Form to the Board of Review within 90 calendar days of receiving the Notice of Decision. You can also request a second medical evaluation within 14 days of the Denial Letter.

Acceptable proof of residency includes a valid driver's license, utility bill, Medicaid card, vehicle registration, passport, Social Security card, or birth certificate. If you have recently moved, you may need approval from the program director, as these decisions are handled on a case-by-case basis.

Note: West Virginia Department of Human Services (DOHS) caseworkers are not required to provide proof of residency for individuals under the State's care.

If you cannot find an approved provider in your area within the 14-day window, contact Psychological Consultation & Assessment (PC&A) for assistance in locating a provider within their network at (304) 776-7230.

Yes, West Virginia Medicaid members and their families can access the 24/7 HELP4WV Children’s Crisis and Referral Line for connections to additional services based on their needs. CSEDW members on the waitlist can also reach out to their Aetna case manager for questions and referrals.