Wraparound and the RTC Medicaid Waiver

Wraparound

In an effort to keep children with intensive mental health needs out of RTCs and in their communities, Maryland has adopted a “wraparound” approach to serving children with serious and complex mental health and behavioral needs. The Care Management Entities (CMEs) are the coordinators for wraparound services.

Maryland has divided the state into three regions and has contracted with Care Management Entities to implement wraparound. A CME is not a service provider, but coordinates care for youth with very complex mental health or behavioral needs and their families. These youth are typically involved with multiple providers and systems. CMEs serve as the “clinical home” for high utilizing populations of children with serious mental health or behavioral challenges.

A child and family must be approved to participate in wraparound. Families may contact the Care Management Entity directly so see if their child is eligible for wraparound. There are presently several ways that a child may be eligible.

• RTC Children’s Mental Health Medicaid Waiver – For children who meet medical necessity criteria for residential treatment. A treating psychiatrist must state that the child requires 24/7 treatment.
• Juvenile Services – For children in Juvenile Services who are referred for wraparound instead of placement out-of-home.
• Social Services – For children in foster care who are referred for wraparound instead of a group home.
• Maryland Cares in Baltimore City – For youth in the Baltimore City foster care system, at the point of initial diagnosis of serious emotional disturbance, in order to prevent out-of-home placement or disruption in the first placement.
• Rural Cares on the Eastern Shore – For youth in the Eastern Shore foster care system, at the point of initial diagnosis of serious emotional disturbance, in order to prevent out-of-home placement or disruption in the first placement.

The Care Management Entities in each region are:

“Wraparound” is a team approach to supporting and servicing children with serious mental health and behavior problems and their families, by implementing a plan that provides services and supports that are “wrapped around” the child and family.

Wraparound is very different than traditional “programs” that serve families, and includes the following components:

• The family is always at the center of the planning process – the family has as much say about the plan as the agencies involved in a child’s plan.
• The family builds the team. They choose the people they want to be on their Child and Family team.
• The focus is on the strengths of the child and family, not deficits.
• The family and team can make creative choices. The child’s and family’s plan will be one-of-a kind with the specific services and supports that the child and family need.

Once a family is approved for wraparound, and there are available slots, the Care Management Entity will help the family coordinate care and access services and supports. The Care Management Entity will assign a Care Coordinator to guide this process. The job of the Care Coordinator is to:

• Help you identify your family’s strengths, needs and supports
• Make sure your voice is heard
• Arrange and prepare for meetings
• Create a plan of care based upon strengths and needs
• Coordinate services in the plan
• Monitor the plan of care
• Develop your family’s crisis plan with you

The family is also connected with a Family Support Partner from MCF. The job of the Family Support partner is to:

• Provide emotional support to a family
• Identify people that a family wants on their Child and Family Team
• Help families decide what they want and need
• Support families in their efforts to get their needs met
• Work with families to organize and prepare for meetings
• Attend meetings with families, such as at school or court
• Connect families with information and resources
• Offer support groups, educational programs and other family activities

The length of time that a child and family can participate in wraparound depends on how the child was referred. The usual length of time is 9-24 months. During that time, the Child and Family Team will be working with the family to help them transition out of formal wraparound, making sure that a family has all of the natural supports in place that they and their child need to succeed.

The RTC Medicaid Waiver

Families may access wraparound through the RTC Medicaid Waiver. Many children who meet the level of care for an RTC are eligible to participate in the waiver in lieu of placement in an RTC.

Because of the specialized services, the RTC waiver has a limited number of openings, or slots, each year. Families may have to wait for an open slot before their child can receive services through the RTC Waiver. Presently, there are 210 waiver slots for the entire state.

Children in the waiver are eligible for all Medicaid services. In addition, the RTC waiver includes seven services that are not normally available through Medicaid. These services are:

• Caregiver peer-to-peer support
• Crisis stabilization services
• Expressive and experiential behavioral services (art, dance/movement, drama/psychodrama, equine, horticultural, and music)
• Family and Youth Training
• Respite Care (In-Home and Out-of Home)
• Youth peer-to-peer support

Each of the services has its own Medical Necessity Criteria that must be met in order for the service to be authorized for a waiver participant.

The RTC Medicaid Waiver is administered by the Care Management Entities. The CMEs serve as an entry point and help families go through the process to apply for the Waiver. For the Care Management Entity in your area, click here.

Everyone applying for the RTC Waiver must complete an application through their regional Care Management Entity. CMEs are available to help fill out application packets and assist in the application approval process. They will also help determine if there are slots available. When all of the paperwork has been submitted, it will be reviewed to determine whether a child meets all of the eligibility requirements. The family will be notified whether or not their child qualifies for the waiver.

In order to participate in the waiver, children and youth must receive a Certificate of Need indicating that they meet Medical Necessity Criteria for RTC-level of care. Participants must be able to be safely and appropriately served in their community with waiver services and supports, and they must be between the ages of 6 and 20 years at the time of enrollment. Participants must meet financial eligibility requirements, but there is no requirement for participants to be on Medicaid.

Because the Waiver is voluntary and the waiting list may take time, a family may still pursue the option of an RTC. Their child’s name would remain on the Waiver waiting list while they are in an RTC. When their name comes to the top of the waiting list and there is an opening, the child can return home from the RTC and enter the Waiver in the community. The child must continue to meet the Medical Necessity Criteria to be considered for the Waiver. If a child leaves an RTC and no longer meets the RTC Medical Necessity Criteria, they would not be eligible for the Waiver when they return home.

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