Medically Fragile Children

A child is "medically fragile" if he or she has a chronic debilitating condition or conditions, and meets one or more of the following criteria: 

  • is technologically dependent for life or health sustaining functions
  • requires complex medication regimens or medical interventions to maintain or to improve their health status 
  • is in need of ongoing assessment or intervention to prevent serious decline of health status or medical complications that put life, health, or development at risk

Chronic debilitating conditions include, but are not limited to: 

  • bronchopulmonary dysplasia
  • cerebral palsy
  • congenital heart disease
  • microcephaly
  • pulmonary hypertension
  • muscular dystrophy

A child requires a "Medically Fragile Level of Care" if he or she is under the age of 21 and:

  • A licensed practitioner has, under state law, determined in writing that the child is at risk of institutionalization
  • Written clinical documentation has been submitted to support this determination
  • The child meets hospital or nursing facility admission criteria after a face-to-face assessement
  • The child is eligible to receive LOC Home and Community Based Services (HCBS) and Community First Choice Option (CFCO) services if CFCO requirements are met

How Fidelis Care Can Help

Fidelis Care offers the Children's Health and Behavioral Health Program for Medicaid Managed Care members under the age of 21. This enhanced Medicaid Managed Care benefit package offers a wide range of children and family treatment support services and children’s home and community based services for qualifying members and their caregivers. 

Case Management

Our case managers can provide support and encouragement to help improve your health. In addition to supporting behavioral health, case management services are available for many conditions and situations including, but not limited to, the following:

  • Asthma
  • Diabetes
  • Heart disease
  • Pregnancy case management
  • Behavioral health conditions
  • HIV and AIDS
  • Hemophilia
  • Sickle Cell Disease
  • Complex Case Management
  • Population Health Management 
    • Keeping members healthy with flu shot reminders
    • Transitional care case management program after a hospital discharge
    • Referrals to Health Homes 
    • Services for members with behavioral and medical needs 
    • Medication reconciliation

To receive more information or to refer a patient, please contact our Clinical Services Department at 1-800-247-1441 from 8:30 AM to 5 PM Monday through Friday.

To learn about appointing a health care agent in New York State, download the Health Care Proxy Form (PDF) from the New York State Department of Health. 

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