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Federal Entitlement to Medicaid and Early Childhood Intervention (ECI) Services

Date: 07/14/22

Attention: Home Health Agencies and Rehabilitation Centers

Early Childhood Intervention (ECI) is a statewide program for families with children, birth to three years of age, with disabilities and developmental delays. This program is available to Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids) members. ECI supports families to help their children reach their potential through developmental services. Services are provided by a variety of local agencies and organizations across Texas.

If a member has a developmental delay or disability, required identification and referral is needed within two Business Days for the ECI program, or members may need to meet other ECI criteria specific to the program. Members may have self-referrals to any network ECI provider.

Member Right to Receive both ECI and Medically Necessary Medicaid Covered Services

Section 1905(r)(5) of the Social Security Act requires that a Medicaid recipient 21 years of age or younger must receive the health care services listed in the Act for which they have a medical need. There is no prohibition to ECI contractors and non-ECI providers from providing services to the same child.

The child is entitled to receive medically necessary services if the family of a child with Medicaid wants additional services, other than or in addition to what the ECI contractor provides including, but not limited to:

  • Occupational therapy
  • Physical therapy
  • Speech therapy

If there is medical necessity for Medicaid services, the child is entitled to receive their services from multiple providers. Access to ECI services cannot:

  • Be denied or reduced because a family wishes to receive additional Medicaid services.
  • Create a barrier to the child’s access to ECI services.

Based on federal statutory language, rules, and subsequent guidance, families do not have to choose between ECI and other Medicaid service providers.

If you have questions, please your local Account Manager.