Rosie D.
Reforming the Mental Health System in Massachusetts

Application & Eligibility

Eligibility for Home-Based Services


The Court’s order in Rosie D. applies to children and adolescents under the age of 21 who reside in Massachusetts and meet the following criteria:


·         Are eligible for MassHealth, the Massachusetts Medicaid program, under either MassHealth Standard or CommonHealth;

·         Are diagnosed with a serious emotional, behavioral or psychiatric condition meeting the federal definitions of serious emotional disturbance; and

·         Are determined through a mental health evaluation to need home-based services.


Families in a MassHealth eligibility category other than MassHealth Standard or Commonwealth can receive home-based services if they transfer to CommonHealth.  All children with SED should be eligible for CommonHealth. 


Children who do not have SED may still be eligible to receive many of the new home-based services.  There are eligbility requirements (called medical necessity criteria) for each new home-based service.  Click to see the medical necessity criteria for intensive care coordination, family partners, mobile crisis, crisis stabilization, in-home therapy, in-home behavior, and therapeutic mentoring services.


Serious Emotional Disturbance


The federal Substance Abuse & Mental Health Services Administration (SAMHSA) and the Individuals with Disabilities Act (IDEA) offer slightly different definitions of serious emotional disturbance.  Together, these federal definitions cover children whose lives are impacted at home, in school and in community activities.  The Court held that: “Any child satisfying the SED criteria used in the IDEA or by SAMHSA, or both, will be eligible for services.”


The SAMHSA definition of SED applies to a child or youth who currently or within the last 12 months has had a diagnosable mental, behavioral or emotional disorder that resulted in functional impairment which substantially interferes with or limits his/her role or functioning in family, school or community activities.


The IDEA defines SED as a condition exhibiting one or more of the following characteristics over a long period of time and adversely affects a child’s educational performance:


·         an inability to learn that cannot be explained by intellectual, sensory or health factors;

·         an inability to build or maintain satisfactory interpersonal relationships with peers and teachers;

·         inappropriate behaviors or feelings under normal circumstances;

·         general pervasive mood of unhappiness or depression; or

·         a tendency to develop physical symptoms associated with personal or school problems.


Children with SED who also are diagnosed with another disabling condition, such as autism spectrum disorders, developmental disabilities or substance abuse also are eligible for home-based services under the Rosie D. Remedial Plan. 


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