Additional Eligibility Information

Who is eligible for Family-Centered Early Supports and Services (ESS)
Known sometimes as “early intervention”, family-centered early supports and services in New Hampshire are for children from birth through two years of age who have or are at risk of having a substantial developmental delay. There are three eligibility categories for Family-Centered Early Supports and Services (from NH state standard He-M 510):
Developmental Delay:  birth through age 2, with a 33 percent delay in one or more of the areas listed in He-M 510 including:

  • Physical development, including vision and/or hearing
  • Cognitive development
  • Communication development
  • Social or emotional development
  • Adaptive development

OR a child with an atypical behavior that exhibit at least one of the following:

  • Extreme fearfulness or other modes of distress that do not respond to comforting by caregivers;
  • Self-injurious or extremely aggressive behaviors
  • Extreme apathy
  • Unusual and persistent patterns of inconsolable crying, chronic sleep disturbances, regressions in functioning, absence of pleasurable interest in adults and peers, and inability to communicate emotional needs;
  • Persistent failure to initiate or respond to most social situation

*****The delay or atypical behavior must be documented by the family and by personnel listed in NH state standard He-M 510.09

At risk for substantial developmental delay:  A child affected by 5 or more of the following documented conditions, events or circumstances, including:

  • birth weight less than 1500 grams
  • respiratory distress syndrome
  • gestational age less than 27 weeks or more than 44 weeks
  • asphyxia
  • nutritional problems that interfere with growth and development
  • intracranial hemorrhage grade III or IV

Documented conditions, events or circumstances affecting a parent including:

  • developmental disability
  • psychiatric disorder
  • family history of lack of stable housing
  • parental education less than tenth grade
  • social isolation
  • substance addiction
  • either parent less than 18 years old
  • parent/child interactional disturbances
  • founded child abuse/neglect

Child with an established condition:  a child with a diagnosed physical or mental condition which has a high probability of resulting in a developmental delay, even if no delay exists at the time of referral, including, at a minimum, conditions such as:

  • Chromosomal anomaly/genetic disorder
  • Inborn metabolic fault

OR a child who has an atypical behavior that exhibits at least one of the following:

  • Extreme fearfulness or other modes of distress that do not respond to comforting by caregivers;
  • Self-injurious or extremely aggressive behaviors
  • Extreme apathy
  • Unusual and persistent patterns of inconsolable crying, chronic sleep disturbances, regressions in functioning, absence of pleasurable interest in adults and peers, and inability to communicate emotional needs;
  • Persistent failure to initiate or respond to most social situations
  • Congenital malformation
  • Severe infectious disease
  • A neurological disorder
  • A sensory impairment
  • A severe attachment disorder
  • Fetal alcohol syndrome
  • Lead poisoning
  • Developmental delay secondary to severe toxic exposure

How to apply for Family-Centered Early Supports and Services

The referral and intake processes for Early Supports and Services (ESS) are:

  • A parent, pediatrician, family doctor, hospital or other person contacts One Sky’s ESS Intake Coordinator to make a referral. The ESS system has 45 days from date of referral to evaluate and determine a child’s eligibility.
  • The Intake Coordinator assigns an ESS agency to the family. (Specialty ESS agencies contract with One Sky to evaluate children and provide services.)
  • ESS professional completes intake visit at the family home, or other location if preferred. The visit includes a review of eligibility criteria and categories, family’s rights, child’s medical and developmental history, the obtaining of permissions and releases signed).
  • ESS agency schedules eligibility evaluation: a play-based assessment with a minimum of two qualified examiners to be done in family home or other natural environment).

IF DETERMINED ELIGIBLE:

  • Individualized Family Support Plan (IFSP) written within 45 days of referral
  • Developmental services begin
  • Review IFSP in 6 months (or fewer)
  • Yearly developmental assessment

IF DETERMINED INELIGIBLE:

  • Family may appeal/request review
  • May be referred again to ESS
  • Community resources identified
  • “Child Check” information shared
  • If necessary, transition to community resources at age 3

Who is eligible for Services to Individuals with a Developmental Disability (3 years and older)?

“Developmental disability” is defined in New Hampshire:

  • That which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and
  • That which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.

How to apply for services

  • Anyone can make a referral for services. The individual, parent, or other person, pediatrician, family doctor, ESS agency, hospital needs to contact One Sky’s Intake Coordinator to make a referral.
  • The Intake Coordinator schedules an intake appointment with the individual, family or guardian. The meeting includes a review of eligibility criteria and individual rights, area agency services and community resources, the individual’s medical and developmental history, and obtaining of permissions and releases signed.
  • The Intake Coordinator collects documentation needed to determine eligibility from sources such as physician, school district, specialists, etc.
  • A Central Eligibility Specialist reviews available documentation to recommend eligibility within 15 or 30 business days, depending on timeframe approved by applicant/guardian (An ineligible determination must be made within this time frame if sufficient documentation has not been received to support eligibility). Based on the Eligibility Specialist’s recommendation, One Sky makes determination of eligibility.

IF DETERMINED ELIGIBLE
Two types of eligibility:                 Unconditional (all ages – permanent eligibility)

Conditional (ages 0-21, temporary eligibility)

PERIODIC REVIEW OF CONDITIONAL ELIGIBILITY
Conditional Eligibility is assigned to young people when it cannot be predicted how long their delays or disabilities will meet New Hampshire’s definition of developmental disability. Conditional eligibility for services is reviewed from time to time. Prior to age 22, Unconditional (permanent) eligibility must be established for ongoing area agency services.

IF DETERMINED INELIGIBLE
Individual may appeal/request review

Who is Eligible for Family Support Services?

Any family (birth, adoptive, or extended) with a member who has a developmental disability at home who has been found eligible for area agency services is eligible for Family Support Services. This includes families with children from birth to age three who are at risk for a substantial development delay and/or eligible for Family Centered Early Supports & Services.

Who is Eligible for Acquired Brain Disorder (ABD) Services?

Acquired brain disorder” is defined in New Hampshire as a disruption in brain functioning that:

  • Is not congenital or caused by birth trauma;
  • Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;
  • Occurs prior to age 60; and
  • Is attributable to one or more of the following reasons:
    • External trauma to the brain as a result of:
      • A motor vehicle incident;
      • A fall
      • An assault
      • Another related traumatic incident or occurrence;
    • Anoxic or hypoxic injury to the brain such as from:
      • Cardiopulmonary arrest;
      • Carbon monoxide poisoning
      • Airway obstruction
      • Hemorrhage
      • Near drowning
    • Infectious diseases such as encephalitis and meningitis
    • Brain tumor
    • Intracranial surgery
    • Cerebrovascular disruption such as a stroke
    • Toxic exposure
    • Other neurological disorders such as Huntington’s disease or multiple sclerosis which predominantly affect the central nervous system; and
    • Is manifested by:
      • Significant decline in cognitive functioning and ability
      • Deterioration in personality, impulse control, judgment,  modulation of mood, awareness of deficits

The area agency can only provide services under NH state standard He-M 522, including Service Coordination, that are reviewed and approved by the Head Injury Services of the NH Bureau of Developmental Services (1-800-852-3345, ext. 5035).

How to apply for Acquired Brain Disorder Services

If you decide to apply for services at One Sky an Intake Coordinator will help you through the intake process.

  • Anyone can make a referral for services. The individual, parent, or other person, pediatrician, family doctor, ESS agency, hospital, etc., contacts One Sky’s Intake Coordinator to make a referral.
  • The Intake Coordinator schedules an intake appointment with the individual, family or guardian. The meeting includes a review of eligibility criteria and individual rights, area agency services and community resources, the individual’s medical history, and obtaining of permissions and releases signed.
  • The Intake Coordinator collects documentation needed to determine eligibility from sources such as physician, hospitals, rehabilitation centers, specialists, etc.
  • A Central Eligibility Specialist reviews available documentation to recommend eligibility for time-limited Targeted Service Coordination (He-M 522) within 15 or 30 business days, depending on timeframe approved by applicant/guardian (An ineligible determination must be made within this time frame if sufficient documentation has not been received to support eligibility). Based on the Eligibility Specialist’s recommendation, One Sky makes a determination of eligibility for Targeted Service Coordination.

For applicants who apply for the Acquired Brain Disorder Community Care Eligibility Waiver (He-M 503), determination of eligibility for Targeted Service Coordination must be made first. Waivered services require that the applicant be eligible for Medicaid and need a Skilled Nursing Facility (SNF) level of care or specialized inpatient rehabilitative services. One Sky sends necessary documentation to the NH Bureau of Developmental Services (BDS) with a recommendation for waivered services, and the Bureau determines eligibility. If ineligible for waivered services, grant funds may be available through BDS and the Brain Injury Association of NH for Family Support.

Two types of ABD-TBI (Traumatic Brain Injury) Eligibility

  • Targeted Service Coordination (He-M 522)
    • Meets definition of ABD
    • Significant decline in cognitive functioning and functional abilities
    • 22 years of age or older
    • Disorder occurred before age 60
    • Not eligible for Developmental Disability waivered services: 

Any applicant for services whose suspected ABD occurred prior to age 22 shall be evaluated pursuant to He-M 503.05. If the applicant has a developmental disability, he or she shall be provided services pursuant to He-M 503.10” (522.03c)

  • ABD-Community Care Waiver Eligibility (He-M 503
    Disruption in Brain Functioning that:

    • Is not congenital or caused by birth defect
    • Presents a severe and life-long disabling condition which significantly impairs ability to function in the community
    • Significant decline in cognitive functioning and functional abilities
      Attributed to one of the following:

      • External Trauma (MVA)
      • Anoxic or Hypoxic Injury
      • Infectious diseases (encephalitis)
      • Brain tumor
      • Intracranial surgery
      • Cerebrovascular disruptions
      • Other neurological disorder predominantly affecting the Central Nervous System/ Eligible under He-M 522