Trillium Health Resources

Children With Complex Needs Referral

The purpose of this referral form is for identification of Children with Complex Needs, according to eligibility criteria set forth by the Settlement Agreement between NC DHHS and Disability Rights North Carolina, which ensures that youth identified with complex needs are aligned with the appropriate diagnostic testing and services.

 

Please read prior to submitting this form:

Eligibility Criteria: Children with Complex Needs are ages 5-20 with a developmental and/or intellectual disability AND a mental health disorder diagnosis who are Medicaid eligible AND at risk of not being able to return to or maintain placement in a community setting.


Referrals will be reviewed within 2 business days for eligibility/identification and the referrer will be contacted within 5 business days with a disposition and to further assess the member's care management needs.


If you have questions/concerns, contact Trillium's Head of CWCN at lynn.beattie@trilliumnc.org.

 
 
 
 
 
 
 
 
 
 
 
 

Describe in detail why the member is at risk for being unable to return to the community or unable to remain in the community.

 
 
 
 
 
 
 
 
 
 
 
 
Drop your files here