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Effective: 4/22/2025

C7.6 Placement and Caregiving for a Child Designated as Medically Complex

Legal Authority

Introduction

​​​​Caregiving arrangements for a child designated as medically complex must ensure that the caregiver(s) has the knowledge and skills necessary to meet the medical needs of the child. Additionally, the caregiver(s) for a child designated as medically complex must be able to ensure access to all needed medical care. This requires the caregiver(s) to work closely with medical providers, managed care organization (MCO) nurse case manager, and the Department for Community Based Services (DCBS) staff. Children designated as medically complex are also more likely to experience hospitalizations, which may require caregivers to stay at the hospital with the child. ​​​

Practice Guidance


  • A child designated as medically complex may only be placed with a caregiver who is licensed or approved to provide care for a medically complex child.
  • The caregiver is required to receive child-specific training from a health care professional or a resource parent who has been trained by a health care professional. The Child Specific Training form documents the training and competency to meet the child’s needs.
  • The SSW may consult with the regional nurse consultant, who then consults with the central office Medical Support Section and Out of Home Care Branch if a medically complex placement is not located after a medically complex designation has been made. 


Procedure

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The SSW:

  1. Places the child designated as medically complex in an approved medically complex home which may include the following:
    1. DCBS medically complex foster home;
    2. Private child placing (PCP) foster home licensed for medically complex care;
    3. Private child caring (PCC) residential placement licensed for medically complex care; or
    4. Medical facility providing the level of medical care necessary to meet the child's needs.
  2. Verifies that foster or adoptive parents are willing to continue to care for the medically complex child and complete any required training if the child was already in their care before the medically complex designation; 
  3. Consults with the regional nurse consultant as needed to determine the best caregiving arrangements to meet the needs of the child;
  4. Follows procedures in SOP C7.9 Level of Care Assignment​ for any child designated as medically complex, regardless of age, who will be placed in a PCC or PCP placement; 
  5. Refers to SOP C9.12.1 Placement Exception Requests and submits a placement exception request to the service region administrator (SRA) or designee for approval before placement for any of the following circumstances:
    1. A one (1) parent foster or adoptive home that is caring for more than one (1) medically complex child; 
    2. A two (2) parent foster or adoptive home that is caring for more than two (2) medically complex children; or
    3. A home with more than four (4) children, including the foster or adoptive parent's own children, that is caring for a child designated as medically complex.  
  6. Submits a placement exception request through the regional nurse consultant and Medical Support Section to the Director of the Division of Protection and Permanency (DPP) for approval before placement when: 
    1. A child designated as medically complex is placed with a caregiver(s) who has not been licensed or approved for medically complex care; or
    2. The primary caregiver of a child designated as medically complex is employed outside the home;
  7. Ensures completion of the Child-Specific Training form regardless of the placement type.  


​​Contingencies and Clarifications

When a child is placed in the home of a relative or out-of-state, the SSW: 
  • Ensures that the placement provider submits documentation from a medical provider that they can meet the medical needs of the child.  This may be documented on the Child-Specific Training form. 
  • Collects the DPP-104C Medically Complex Monthly Report and provides a copy to the regional nurse consultant and Medical Support Section.


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Documents

Revisions