Respite Handbook
Eligibility Criteria

Respite funding will be available to families whose children are enrolled in Early Intervention and meet one or more of the following criteria:

• Complex care requirements (i.e. child is ventilator assisted, child is fed through a G-tube)
• Multiple disabilities (i.e. child who is visually impaired and has a physical disability)
• Extensive medical/health needs (i.e. child has unique positioning and feeding concerns)

Provided that sufficient funding exists, all eligible families will be able to receive Family Support and Respite Services. Priority must be given to families with low to moderate incomes.

Income Verification Documents
The RCP must verify each family’s income prior to approval for funding. As referenced above, priority will be given to those families who are low to moderate income based on the Federal Poverty Income Guidelines (FPIG) published in the Federal Register (copy of the most recent FPIG found in the attachments). For the purposes of funding respite services, low income refers to families at or below 200% of FPIG based on their gross family income and family size. Based on the same measures, moderate income refers to families at or below 400% of FPIG. DPH will distribute an updated version of the guidelines when necessary. The family’s income must be reverified on an annual basis (one year from the point of initial verification.) To verify the income, one of the following must be submitted to the RCP:

• a copy of payroll stubs for two recent weeks
• a copy of the most recent tax return
• a letter from the employer with the gross pay

In the event that no one is employed and not currently collecting unemployment, the RCP will accept:

• a copy of patient’s bank statement, social security benefit statement, retirement refund documents or court payment records

In the event that an applicant is unemployed and has no source of income, the RCP will accept:

• an affidavit documenting the family’s name, address and source of income and amount (if applicable). The affidavit must be signed by a family member.

Families enrolled in MassHealth (except CommonHealth and Kalleigh Mulligan) do not need to provide income documentation whereas the Division of Medical Assistance (DMA) has already conducted an income determination and found the family to be at or below 200% FPIG. The family will need to follow the criteria outlined above if their child is enrolled in CommonHealth or Kalleigh Mulligan since DMA does not have an income limit for this category.

Please note: all families must provide income verification with the Respite Services Request Form in order for priority determination to be made. Failure to provide requested income documentation will result in automatic denial.