Medical Eligibility Criteria

Eligibility for HRIF Services

Download the CCS HRIF Program Medical Eligibility Criteria - Flow Chart

Age Criteria: A neonate, infant or child is eligible for the HRIF Program from birth up to three years of age. 

Residential Eligibility: The county CCS Program is responsible for determining whether the parent or legal guardian of a HRIF Program applicant is a resident of the county per CCS Program policy. 

Financial Eligibility: Financial eligibility determination is not required for HRIF Program services as the HRIF Program provides diagnostic services only. While financial eligibility is not required, insurance information shall be obtained.

Medical Eligibility: A neonate, infant or child shall be medically eligible for the HRIF Program when the infant:

  • Met CCS Program medical eligibility criteria for NICU care, in a CCS Program-approved NICU regardless of length of stay (per Numbered Letter [N.L.] 05-0502, Medical Eligibility in a CCS Program-approved NICU, or the most current N.L.). NOTE: Medical eligibility includes neonates who require direct admit to a CCS Program-approved PICU, who are never admitted to a CCS Program-approved NICU, but who otherwise meet all medical eligibility criteria for HRIF services in this section.

OR 

  • Had a CCS Program-eligible medical condition in a CCS Program-approved NICU regardless of length of stay, even if they were never CCS Program clients during their stay (per California Code of Regulations, Title 22 Section 41515.1 through 41518.9, CCS Program Medical Eligibility Regulations).

AND

  • The birth weight was less than or equal to 1500 grams or the gestational age at birth was less than 32 weeks.

OR

  • The birth weight was more than 1500 grams and the gestational age at birth was 32 weeks or more and one of the following documented criteria was met during the NICU stay:
  1. pH less than 7.0 on an umbilical cord blood sample or a blood gas obtained within one hour of life or an Apgar score of less than or equal to three at five minutes or an Apgar score of less than 5 at 10 minutes.
  2. An unstable infant manifested by hypoxia, acidemia, hypoglycemia and/or hypotension requiring pressor support.
  3. Persistent apnea which required caffeine or other stimulant medication for the treatment of apnea at discharge.
  4. Required oxygen for more than 28 days of hospital stay and had radiographic finding consistent with chronic lung disease.
  5. Infants placed on extracorporeal membrane oxygenation (ECMO).
  6. Infants who received inhaled nitric oxide greater than four hours, and/or treatment during hospitalization with sildenafil or other pulmonary vasodilatory medications for pulmonary hypertension.
  7. Congenital heart disease (CHD) requiring surgery or minimally invasive intervention.
  8. History of observed clinical or electroencephalographic (EEG) seizure activity or receiving antiepileptic medication(s) at time of discharge.
  9. Evidence of intracranial pathology, including but not limited to, intracranial hemorrhage (grade II or worse), white matter injury including periventricular leukomalacia, cerebral thrombosis, cerebral infarction or stroke, congenital structural central nervous system (CNS) abnormality or other CNS problems associated with adverse neurologic outcome.
  10. Clinical history and/or physical exam findings consistent with neonatal encephalopathy
  11. Other documented problems that could result in a neurologic abnormality, such as:
    • CNS infection
    • Documented sepsis
    • Bilirubin at excessive levels concerning for brain injury as determined by NICU medical staff
    • History of cardiovascular instability as determined by NICU medical staff due to: sepsis, congenital heart disease, patent ductus arteriosus (PDA), necrotizing enterocolitis, other documented conditions.