10b) Initial and Annual Eligibility Determination

ELIGIBILITY CRITERIA

1. Children residing in Illinois who are under the age of three years and their families are initially eligible for Early Intervention (EI) services if written evaluation reports completed by a multidisciplinary team confirm that the child:
   1. Has a developmental delay; or
   2. Has a physical or mental condition which typically results in developmental delay; or
   3. Is at risk of having substantial developmental delays, according to informed clinical judgment.
2. "Developmental delay" means a Illinois Department of Human Services (Department) determined eligible level of delay (30% or greater) in one or more of the following areas of childhood development: cognitive; physical, including vision and hearing; language, speech and communication; social-emotional; or adaptive self-help skills. The eligible level of delay must have been:
   1. Measured by Department approved diagnostic instruments and standard procedures; (see the following Assessment Instruments list) or
   2. Confirmed through informed clinical judgment of the multidisciplinary team if the child is unable to be appropriately and accurately tested by the standardized measures available. Activities used to determine clinical judgment shall include observation and parent report and shall be described in the written evaluation report.
3. "Physical or mental condition which typically results in developmental delay" means a medical diagnosis:
   1. Approved by the Department as an eligible condition; (see the following list of Medical Conditions Resulting in a High Probability of Developmental Delay.) or
   2. Confirmed by a qualified family physician, pediatrician or pediatric sub-specialist as being a condition with a relatively well-known expectancy for developmental outcomes within varying ranges of developmental disabilities. Pediatric subspecialists included are those such as pediatric neurologists, geneticists, pediatric orthopedic surgeons and pediatricians with special interest in disabilities. If a child exhibits a medical condition not approved by the Department as being an eligible condition, the qualified multidisciplinary team may use written verification by one of the physician categories identified above that the child's medical condition typically results in substantial developmental delay within the varying ranges of developmental disabilities.
4. "At risk of substantial developmental delay, according to informed clinical judgment" means the multidisciplinary team confirms that development of a Department determined eligible level of delay (30% or greater) is probable if EI services are not provided because the child is experiencing either:
   1. A parent who has been medically diagnosed as having a severe mental disorder as set forth under axis I and axis II of the Diagnostic and Statistical Manual (DSM) IV or a developmental disability; or
   2. Three or more of the following risk factors:
      1. Current alcohol or substance abuse by the primary caregiver;
      2. Primary caregiver who is currently less than 15 years of age;
      3. Current homelessness of the child. Homelessness is defined as children who lack a fixed, regular and adequate nighttime residence, in conformity with the McKinney Vento Homeless Assistance Act;
      4. Chronic illness of the primary caregiver;
      5. Alcohol or substance abuse by the mother during pregnancy with the child;
      6. Primary caregiver with a level of education equal to or less than the 10th grade, unless that level is appropriate to the primary caregiver's age;
      7. An indicated case of abuse or neglect regarding the child and the child has not been removed from the abuse or neglect circumstances.
5. Activities used to determine by clinical judgment that development of an eligible level of delay (30% or greater) is probable if EI services are not provided and presence of risk factors shall include observation and parent report and shall be described in the written evaluation report.
6. If a family removes a child from services prior to reaching age three years and the child is later referred again, the child must meet eligibility criteria in effect at the time of the subsequent referral in order to be re-enrolled. NOTE: Service Coordinators must complete all steps required to complete an initial IFSP when re-enrolling a child that was previously removed from the program, beginning with the Intake process.

POLICY:

1. Evaluations to determine initial eligibility or the need to add a new service to the IFSP shall be provided by credentialed/enrolled Evaluators only.
2. Evaluations must be obtained from a minimum of two disciplines to determine initial eligibility and re-determine eligibility for services. NOTE: One person cannot evaluate as two disciplines for a single child/family.
3. Eligibility must be re-determined at the end of each annual Individualized Family Service Plan (IFSP) period using Department determined eligibility criteria in effect at the time of the annual evaluation. NOTE: Refer to Individualized Family Service Plan Section for the Required Annual Reviews procedure. Children who do not meet current eligibility criteria upon re-determination will continue to be eligible only if they:
   1. Exhibit any measurable delay or have not attained a level of development in one or more developmental areas that is at least the mean of the child's age equivalent peers; and
   2. Have been determined by the multidisciplinary IFSP team to require the continuation of EI services in order to support continuing developmental progress.
4. When an application or review of eligibility for EI services is made and at any eligibility re-determination thereafter, Service Coordinators shall determine a family's enrollment status in All Kids and complete an All Kids Application and make a referral to the Division of Specialized Care for Children (DSCC), if indicated.

PROCEDURE:

1. Review all evaluations and medical reports with the family to ensure that two or more disciplines participated in and are in agreement with the determination of eligibility and to determine if the child meets EI eligibility criteria. NOTE: One person cannot evaluate as both disciplines.
   1. Verify that the initial evaluations were conducted by credentialed/enrolled Evaluators.
2. If the child is eligible for EI complete the following steps:
   1. Enter Cornerstone eligibility determination information. NOTE: Refer to the Cornerstone Reference Manual for instructions.
   2. Send eligible form letter #30.F32 to provide written notice of the child's eligibility. With parental consent (see Intake) copy the referral source.
   3. Coordinate and authorize any additional evaluations needed for the development of the IFSP. Utilize only credentialed/enrolled Evaluators to complete initial evaluations.
   4. Contact the family to discuss eligibility.
   5. Explain voluntary family assessment (Family Considerations page of IFSP).
   6. Inform family that written proof of income and insurance will be required at the time of IFSP development, including proof of All Kids enrollment if applicable.
3. If the child is NOT eligible for EI the Service Coordinator shall complete the following activities:
   1. Contact the family in order to provide verbal notification of ineligibility for EI.
   2. Provide written notification of ineligibility determination to the family by sending Ineligible Based on Evaluation form letter #30.F28 indicating EI ineligibility and right to dispute the determination. (Refer to Procedural Safeguards and Disputes section). Upon receipt of a signed Consent to Release Information form (see Intake), copy the referral source at initial eligibility determination.
      1. Provide ten (10) days notice before discontinuing services if the child was found ineligible through annual re-evaluation. Send sample form letter 30.F28, Ineligible Based On Evaluation, Sample 2: Ineligible - Annual eligibility Determination.
   3. Discuss other community resources and refer to those resources, as appropriate.
   4. Document the child's ineligibility for EI in Cornerstone case notes.
   5. Edit the child's level of delay on the EI Program Data screen, if necessary.
   6. Complete case closure. (Refer to Transfers and Case Closure section).