Special Services for Children | EmblemHealth

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Special Services for Children

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It’s important to care for your child’s physical and mental wellbeing. A pediatrician is a primary care doctor for children age 18 and under. A pediatrician manages your child’s health and arranges referrals to any specialists your child may need. Call your child’s pediatrician when they need medical care such as annual check-ups and vaccines. To learn more about the screenings, tests ,and shots your child needs, see our Preventive Health Guidelines.

For help finding a pediatrician or specialist, call us at 855-283-2146 (TYY: 711). Our hours are 8 am to 6 pm, Monday through Friday. You can find a doctor online using Find a Doctor.

Care for Your child’s mental health

If your child is struggling with mental health challenges or substance use, we can help. Your child’s mental health benefits are provided through our partner, Carelon Behavioral Health (formerly Beacon Health Options). To find a mental health provider, go online or call 888-447-2526 (TTY: 711).

Children and Family Treatment and Support Services (CFTSS)

Children/youth under 21 and their families may be able to get additional mental health and substance use services through Medicaid. These services, listed below, are provided at home or in the community.

Service Description
Community Psychiatric Support & Treatment Services to help members learn about their behavioral health needs and receive supportive therapy.
Psychosocial Rehabilitation Behavioral health services designed to support a child's/youth's ability to reach appropriate developmental functioning.
Other Licensed Practitioner Non-physician licensed behavioral health therapist who provides clinical services to help members with their behavioral health needs.
Family Peer Support Services Activities and supports for families caring for/raising a child who is experiencing social, emotional, medical, developmental, substance use, and/or behavioral health issues in the home, school or in the community.
Crisis Intervention Behavioral Health treatment provided to children and youth experiencing serious psychological/ emotional issues that require urgent attention.
Youth Peer Support and Training Services for youth experiencing social, medical, emotional, substance use, and/or behavioral challenges in their home, school or the community.

Children’s Home & Community Based Services (HCBS)

These services give children and their families the ability to improve their care and their quality of life by identifying needs early and providing support in the home or community. To find out more, contact your healthcare provider, Health Home care manager, or care coordinator.

Service Description
Respite (planned & crisis)

Short term assistance and/or relief for children with disabilities. Direct care services required to support children/youth to improve their performance. Skilled nursing services must be ordered by a physician.

Starting Jan. 1, 2023, Children’s Respite Services must be delivered in-person. EmblemHealth will no longer cover remote respite services delivered by telehealth or telephone. Services can be delivered at a home, community site, or approved facility. This follows NY State Department of Health policy.

Prevocational Services Designed to prepare youth to obtain paid work, volunteer work or learn about various careers.
Supported Employment Services designed to support children/youth to be able to continue work.
Caregiver/Family Supports and Services Improve the child/ youth's ability to remain with their family and improve the caregiver’s ability to care for them in the home/ community.
Community Self-Advocacy Training & Support Assists child and family/caregiver in understanding and addressing the child's needs related to their disability in order to assist the child’s ability to participate with peers in age-appropriate activities.
Habilitation (including Day and Community Habilitation) Assistance with obtaining, retaining or improving member’s ability to help themselves, develop social skills and perform daily living skills to take care of themselves.
*Adaptive and Assistive Equipment Technological aids and devices that enable a child to obtain daily living skills that are necessary to support their health, safety and well-being.
*Environmental Modifications Provides internal and external physical changes to the home or other residence to support the health, safety, independent functioning and well-being of the child.
*Vehicle Modifications Provides physical changes to the primary vehicle of the child which are necessary to support the health, safety, or greater independent functioning of the child.
Palliative Care (Pain & Symptom Management, Bereavement Service, Massage Therapy, Expressive Therapy) Specialized medical care focused on providing relief for the symptoms and stress of chronic or life-threatening illness.
Non-medical transportation Non-medical transportation will be paid by Medicaid for eligible children/youth, whether the child/youth is enrolled in Medicaid Managed Care or not.

*Starting July 1, 2024, some children’s HCBS (environmental and vehicle modifications and adaptive and assistive technology) will be covered by Medicaid fee-for-service. If eligible, you will still be able to receive these services, but these three services will be set up by a Health Home Care Management Agency (CMA). Your care manager will help to arrange these services.

Other Limited Health-Related Services (OLHRS)

EmblemHealth will cover these services for any child/youth 21 years old or younger if they are placed with or receive these services from a 29-I VFCA Health Facility. Other Limited Health-Related Services include CFTSS and HCBS listed above as well as Medicaid State Plan Services. The Medicaid State Plan Services include the following:

  • Screening, preventive, diagnostic and treatment services related to physical health. This includes but is not limited to:
    • Ongoing treatment of chronic conditions as specified in treatment plans
    • Diagnosis and treatment related to episodic care for minor ailments, illness or injuries, including sick visits
    • Primary pediatric/adolescent care
    • Immunizations in accordance with NYS or NYC recommended childhood immunization schedule
    • Reproductive health care
  • Screening, preventive, diagnostic and treatment services related to developmental and behavioral health. This includes:
  • Psychiatric consultation, assessment, and treatment
  • Psychotropic medication treatment
  • Developmental screening, testing, and treatment
  • Psychological screening, testing and treatment
  • Smoking/tobacco cessation treatment
  • Alcohol and/or drug screening and intervention
  • Laboratory tests

Other Limited Health-Related services do not include: surgical services, dental services, orthodontic care, general hospital services including emergency care, birth center services, emergency intervention for major trauma, treatment of life-threatening or potentially disabling conditions.