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Children with Medical Complexity

In compliance with Budget Epilogue Section 141 of the State of Delaware’s Legislature, 149th Generally Assembly’s act making appropriations for the expense of the State Government for the fiscal year ending June 30, 2018; specifying certain procedures, conditions and limitations for the expenditure of such funds; and amending certain pertinent statutory requirements [House Substitute No. 1 (HS1) for House Bill No. 275 (HB275)], Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) has published a comprehensive plan for children with Medical Complexity.

Identifying Children with Medical Complexity –

A working definition

Children with medical complexity are a subset of children and youth with special health care needs because of their extensive health care utilization. For the purpose of this work, a child is considered medically complex if she/he falls into two or more of the following categories:

  • Having one or more chronic health condition(s) associated with significant morbidity or mortality;
  • High risk or vulnerable populations with functional limitations impacting their ability to perform Activities of Daily Living (ADLs);
  • Having high health care needs or utilization patterns, including requiring multiple (3 or more) subspecialties, therapists, and/or surgeries;
  • A continuous dependence on technology to overcome functional limitations and maintain a basic quality of life.

The Children with Medical Complexity Steering Committee developed this broad definition of children with medical complexity to aid in the development of a Delaware’s Plan for Managing the Health Care Needs of Children with Medical Complexity, as well as to assist in the work this group is continuing to embark on. This definition is not intended to serve as the basis for denying or authorizing care and/or payment for care for children served through the Delaware Medicaid Program.


Strengthening Health Care Delivery Systems for Children with Special Health Care Needs and the Role of Quality Measurement

As more states serve Children and Youth with Special Health Care Needs (CYSHCN) in Medicaid managed care, it is important to understand the unique needs of CYSHCN and how program and policy changes impact their access to high quality care. Delaware participated in a National Academy for State Health Policy (NASHP) learning collaborative focused on improving Medicaid managed care for CYSHCN. The link below will lead you to a webinar with presenters from Delaware, Rhode Island, and Massachusetts, who recently participated in this learning collaborative.

Improving Care for Children with Complex Medical Needs

DMMA Director Stephen Groff participated in an Alliance for Health Policy public briefing with other panelists to discuss factors that influence the quality, affordability, and accessibility of care for children with complex medical needs.