Children and Youth with Special Health Care Needs Program
The Children and Youth with Special Health Care Needs Program provides assistance statewide for individuals from birth to age 21 who have or are at increased risk for a medical condition that may hinder their normal physical growth and development and who require more medical services than children and youth generally. The Program focuses on early identification and service coordination for individuals who meet medical eligibility guidelines. As payor of last resort, the Children and Youth with Special Health Care Needs Program provides limited funding for medically necessary diagnostic and treatment services for individuals whose families also meet financial eligibility guidelines.
Program Eligibility Requirements
- Be a Missouri resident
- Be birth to age 21
- Have an eligible special health care need (conditions such as Cerebral Palsy, Cystic Fibrosis, Cleft Lip and Palate, Hearing Disorders, Hemophilia, Paraplegia, Quadriplegia, Seizures, Spina Bifida, and Traumatic Brain Injury)
- Meet financial eligibility guidelines for funded services (family income at or below 185% of the Federal Poverty Guidelines)
The Children and Youth with Special Health Care Needs Screener is the first tool utilized when determining an individual’s eligibility for the Children and Youth with Special Health Care Needs Program. Please see the screener below for additional information.
Financial Eligibility (for medically necessary diagnostic and treatment services)
Financial eligibility is based on family income and size.
Family income is determined by your Internal Revenue Service income tax form. This form is required with your application for services. Income consists of the Adjusted Gross Income of the Federal Internal Revenue Service income tax form. An estimated income can be substituted for the Adjusted Gross when the income tax form is not reflective of the family’s current financial status.
Family size is determined by the number of person(s) listed on your income tax form, if available. Your local Children and Youth with Special Health Care Needs Service Coordinator can help you determine financial eligibility.
Financial Eligibility Guidelines
Enrollment Dates: January 1, 2025 – December 31, 2025 (or until the Federal Poverty Guidelines are updated)
| Family Size | Annual Income 2024 |
|---|---|
| 1 | $28,952.50 |
| 2 | $39,127.50 |
| 3 | $49,302.50 |
| 4 | $59,477.50 |
| 5 | $69,652.50 |
| 6 | $79,827.50 |
| 7 | $90,002.50 |
| 8 | $100,177.50 |
| Each Additional Family Member Add | $10,175.00 |
*Estimating annual income: Multiply weekly paystubs by 52 or monthly paystubs by 12.
Services Available through the Program
The Children and Youth with Special Health Care Needs Program provides two primary services:
- Service coordination is provided to all participants, regardless of financial status. Service Coordination includes:
- Outreach/Identification and Referral/Application
- Eligibility Determination
- Assessment of Needs
- Resource identification, referral and access
- Family support
- Service Plan Development/Implementation
- Monitoring and Evaluation
- Transition/Closure
- Limited funding for medically necessary diagnostic and treatment services for participants whose families meet financial eligibility guidelines. Funded services may include but are not limited to:
- Doctor visits, emergency care, inpatient hospitalization, outpatient surgery, prescription medication, diagnostic testing, orthodontia and prosthodontia (cleft lip/palate only), therapy (physical, occupational, speech and respiratory), durable medical equipment, orthotics, hearing aids, specialized formula, and incontinence supplies.
Children and Youth with Special Health Needs is payor of last resort. The Service Coordinator will assist the participant/family with resource identification and referral. All third-party liability must be exhausted prior to accessing Children and Youth with Special Health Needs funds.
How to Apply
Contact the Children and Youth with Special Health Care Needs Service Coordinator in your designated region to make a referral or complete and submit the Application for Enrollment form provided in the links below: