Care at Home

for Children

​with Serious

Emotional Disorders

​

The CSEDW ​is for members who:

• Are between the ages of three and 21
• Are a resident of West Virginia, even if they are now living out of state in a psychiatric residential treatment facility (PRTF). Proof of West Virginia residency is required with the waiver application.
• Meet the program eligibility.
  
• Choose home and community-based treatment services instead of services in a medical facility or group home.
  
• Choose to sign up with the identified managed care organization (MCO).
  
• Currently or at any time during the past 12 months, have been diagnosed with a mental, behavioral or emotional disorder for a period of time that is satisfactory to meet standards that are in the most current edition of the Diagnostic and Statistical Manual (DSM).
  
• Have a Child and Adolescent Functional Assessment Scale (CAFAS) or Preschool and Early Childhood Functional Assessment Scale (PECFAS) score of "severe" (score of 90 or above is considered severe).​

The CSEDW program provides services that include:

​For more information or to get help with th​e application, contact:

Acentra Health

1007 Bullitt Street, Second Floor

Charleston, WV 25301

Phone: (866) 385-8920 | (304) 380-0617​

Fax: (866) 521-6882

Email: wvcsedw@kepro.com​

1. ​​​​​​​​Does my child have to be in a care facility or getting treatment outside of West Virginia?
   No. However, eligible children/youth with serious emotional disorders (SED) will be given preference who are: ​
   ​a. ​In psychiatric residential treatment facilities (PRTFs) or other residential treatment providers either out-of-state or in-state; and
   b. Eligible for Medicaid and are at risk of being placed in a medical care facility.
   
   
2. Can I apply for CSEDW services while on another waiver waitlist?
   Yes. However, you cannot be on multiple waivers at the same time. Although youth with diagnoses for both conditions are eligible, the CSEDW services must benefit them.
   
   
3. I just had a psychological report done. Can I use that report to apply?
   No. The health care provider must be an approved evaluator by the MECA (Medical Eligibility Contracted Agent), and the CSEDW requires specific tools or tests. It will be helpful if you provide the independent evaluator with a copy of the recent report and other important medical records. 
   
   
4. Can I keep the same therapist if I get the CSEDW?
   For children who have a therapist before they become eligible for CSEDW and their therapist is not enrolled as a CSEDW provider, the Bureau for Medical Services (BMS) and Aetna Better Health of West Virginia have developed a process for them to receive therapy through the Medicaid State Plan. When it is determined that a relationship has been made, the child's team will work with Aetna's care manager and fill out a Coordination of Care Agreement. The agency chosen to provide all the other CSEDW services will be on the form. The form will also state that the primary caregiver wants this option and that in-home family therapy will not be billed for that child under the CSEDW program. Assistance with the Wellness Recovery Action Plan (WRAP) must be kept separate and follow standard policies and procedures for choosing a provider.
   
   
5. How long does the CSEDW last?
   Medical and financial eligibility must be re-established annually. However, this waiver is not for long-term services. The individual child's needs determine the length of the stay, with an expected average of six to nine months. 
   
   
6. Is there an exact list of diagnoses eligible for the CSEDW?
   No, the CSEDW does not have a list of exact SED diagnoses. 
   
   
7. How long does it take to go through the referral process?
   The goal is less than 45 days from referral to getting the decision.
   
   
8. How do I appeal a decision on eligibility?
   The member or parent/legal representative will receive a Notice of Decision in writing if a member is not medically eligible. The decision includes a Request for a Second Medical Examination, a form to Request a Hearing with free places to get legal help, and the reassessment results. The case manager and Aetna Better Health of West Virginia also receive the notice. A member may appeal the denial through the Medicaid Fair Hearing process if they submit the Request for Hearing Form to the Board of Review within 90 calendar days of receiving the Notice of Decision. The member or parent/legal representative can request a second medical evaluation within 14 days from the date on the Denial Letter.
   
   
9. What can I use to prove I live in West Virginia? 
   You can use a valid driver's license, utility bill, Medicaid card, vehicle registration, valid passport (or anything else you have to use your driver's license to get), Social Security card, or birth certificate. If you just moved, you need to get permission from the program director. These decisions are made on a case-by-case basis.
   
   The West Virginia Department of Human Services (DOHS​) case workers are NOT required to provide proof of residency for people in the State's care.
   ​
   
10. How can I get my child evaluated within 14 days if there are no providers on the list in my area or available?
    ​Please contact Psychological Consultation & Assessment (PC&A) to assist you in finding a provider in their network at (304) 776-7230​.​
    
    
11. Are there any services I can use while I am on a waitlist for the CSEDW?
    Yes. West Virginia Medicaid members and their families have access to the 24/7 HELP4WV Children's Crisis and Referral Line for links to additional services. These services are dependent on the member's needs. CSEDW members on the waitlist can also contact their Aetna case manager for questions and referrals.​​
    




12. ​​Are there any services I can use while I am on a waitlist for the CSEDW?

    Yes. West Virginia Medicaid members and their families have access to the 24/7 HELP4WV Children’s Crisis and Referral Line​ for links to additional services. These services are dependent on the member’s needs. CSEDW members on the waitlist can also contact their Aetna case manager for questions and referrals​