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552 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services
Enter additional information into the eXPRS payment system, or
Assist the individual in establishing medical eligibility with ODHS|OHA. Note: The individual must already be on Medicaid for SPPC. Child I/DD services For children with I/DD services, ODHS|OHA manages the medical case while the I/DD case management entity (CDDP or CIIS) provides case management services. Children who receive HSD medical’s CHIP benefits are not eligible for waivered services but may be eligible to receive K Plan services. Children ages 18 to 21 can sometimes retain their OSIPM eligibility. Note: Individuals requesting LTC services are a household of one. However, for children, parental income is required to evaluate HSD medical program eligibility due to the hierarchy of medical programs within ONE. If determined ineligible for HSD medical programs, only the child’s income will be counted for evaluation of APD medical programs. Children’s residential placements The local CDDP will: • Establish service eligibility, • Submit a Presumptive Medical Disability Approval form (DHS 0620) to ODHS|OHA’s Children’s Residential Service Unit, when applicable, • Assist with completion of a medical application, when needed, • Set-up residential placement information in the I/DD system, • Submit a Title XIX Level of Care Waiver Form to TAU for waiver eligibility determination and to create/update the Non-CAPS Service Eligibility record (SELG), and • For foster care placements, send a Data Personal Care Form to ODHS|OHA’s Provider Payments Unit, Community Based Care Payment Processor for entry. The ODHS|OHA eligibility worker will determine eligibility for Medicaid. Note: Children in foster care must all participate in the Trust and Agency (T&A) account system. Workers must also determine if the foster parent or other person should be listed as the authorized representative. Children’s Intensive In-Home Services (CIIS) CIIS has three 1915(c) Home and Community-Based Services (HCBS) model waivers to address the needs of children with disabilities. A child could qualify and receive services through the Intensive Behavior, Medically Involved or Medically Fragile Programs. The intent is to provide appropriate supports and services to ensure health and safety in the family home to prevent out of home placement. CIIS supplement the services that are available through the State Medicaid Plan and other federal, state and local programs, as well as the natural supports that families and communities provide. Anyone can refer a child for CIIS; however, they must use the appropriate form for the specific program for which they are making the referral, as follows: