Family start guide
How to get EIDBI services in Minnesota
A specific family pathway from developmental concerns and a qualified diagnosis through all four EIDBI eligibility requirements, the CMDE, provider selection, authorization and lawful service delivery.
This guide does not replace DHS policy, payer requirements, legal advice or professional judgment. Never change, omit or invent diagnoses, symptoms, service times, signatures, evaluations or household information to obtain eligibility or payment. Report corrections through the responsible provider, health plan, county, Tribal Nation or DHS.
Start with concerns, screening and a real evaluation
A screening can identify concern, but it is not an autism diagnosis. Families can ask the child’s primary care clinician for developmental and autism screening and a referral. Children enrolled in Medical Assistance or MinnesotaCare can use Child and Teen Checkups. Families may also call the insurer for in-network diagnostic providers. School screening or evaluation can identify educational needs, but school records cannot be the only medical evidence for some disability programs.
- Write down specific examples involving communication, social interaction, routines, sensory needs, development and daily functioning.
- Bring honest information from home, medical care, child care and school—even when the sources disagree.
- Do not coach answers, exaggerate symptoms or seek a diagnosis solely to unlock payment.
- Urgent safety or medical concerns belong with a qualified clinician or emergency service, not an online guide.
Understand the diagnosis requirement
Current DHS EIDBI policy requires a diagnosis of autism spectrum disorder or a related condition. The diagnosis must meet Minnesota diagnostic-assessment requirements. A CMDE may also serve as that diagnostic assessment only when it includes every required component. Autism-specific testing is required for an initial diagnosis or when the CMDE also functions as the diagnostic assessment; DHS does not require one specific branded tool.
- Use a qualified professional acting within their license and scope.
- Ask whether the appointment is screening, a diagnostic assessment, a CMDE, or a combined evaluation.
- Ask which records and assessment components support the diagnosis.
- A diagnosis alone does not establish EIDBI medical necessity, coverage or service authorization.
Check all four EIDBI requirements
DHS requires all four: the person is younger than age 21; has autism spectrum disorder or a related condition; has a CMDE establishing medical need for EIDBI; and is enrolled in Medical Assistance, MinnesotaCare, MA-TEFRA or another qualifying health care program. An MHCP-enrolled CMDE provider determines EIDBI eligibility during the CMDE process.
- Confirm active coverage and effective dates with the health plan, county or Tribal Nation.
- Keep the diagnosis and CMDE as separate requirements unless the evaluator documents a valid combined assessment.
- Confirm any required service authorization before treatment starts.
Schedule a CMDE with an enrolled provider
The CMDE identifies strengths and needs and determines EIDBI eligibility and medical necessity. A CMDE provider must meet professional, autism-experience or graduate-coursework, scope-of-practice and MHCP enrollment requirements. Search the MHCP directory using EIDBI and CMDE assessments.
- Bring diagnostic, medical, school and therapy records when available.
- Share the child’s strengths, needs, routines, communication, culture and family priorities.
- Ask whether the provider will complete DHS-7108 and when you will review the results.
Choose an EIDBI provider
Compare agencies by location, treatment approach, language access, setting, caregiver involvement and current availability. Directory presence does not guarantee an opening, so confirm details with each provider.
- Search the AbilityOS public provider directory and verify against DHS.
- Ask whether the provider accepts the child’s coverage and current authorization.
- Ask about waitlists, hours, transportation, service settings and caregiver training.
Review the individual treatment plan
After the CMDE, the qualified supervising professional develops an individual treatment plan with measurable goals and recommended services. The legal representative should understand and agree to the plan before services begin.
- Make sure goals connect to the child’s needs and family priorities.
- Ask how progress will be measured and shared.
- Keep copies of the CMDE, treatment plan, authorization and contact information.
Start only authorized, documented services
Starting dates depend on provider capacity, active coverage and any required service authorization. Services must be delivered by eligible providers, follow the treatment plan, avoid duplication with other Medicaid services, and be documented as actually delivered.
- Never sign a blank, backdated or inaccurate attendance sheet or case note.
- Do not allow billing for missed, overlapping or undelivered services.
- Tell the provider about school, waiver, therapy and other services so teams can coordinate and avoid duplication.
- Report major changes in health, needs, schedule or coverage and ask for corrections in writing.
Common questions
Frequently asked questions
Does my child need a diagnosis before a CMDE?
EIDBI eligibility requires a diagnosis of autism spectrum disorder or a related condition and a CMDE establishing medical need. A CMDE can also qualify as the diagnostic assessment only when the qualified provider includes every diagnostic-assessment requirement. Ask the provider whether the appointment is a CMDE, a diagnostic assessment, or a valid combined evaluation.
Who can help us obtain an autism evaluation?
Start with the primary care clinician or insurer, or search the MHCP directory and Minnesota Autism Portal. Ask the evaluator about licensure, autism assessment experience, payer participation, wait time and whether the evaluation meets the purpose you need, because school, EIDBI and disability programs use different criteria.
Can EIDBI and school services happen at the same time?
They can. EIDBI is a health care benefit and school special education is an education service. The teams should coordinate schedules, goals and information with the family’s permission.
How do I find an EIDBI or CMDE provider?
Use the Minnesota Autism Portal provider directory or the AbilityOS public directory, then contact providers directly to confirm services, coverage and openings.
What if every provider has a waitlist?
Contact several providers, ask about cancellation lists, and update the child’s health plan, county or Tribal contact. Keep truthful records of calls. Do not pay someone to falsify eligibility, skip required evaluation steps or promise guaranteed approval.
From guidance to daily work
Keep documentation, supervision and progress connected.
AbilityOS is independent Minnesota EIDBI operations software for organizing documentation, authorizations, staff readiness, progress and review workflows.
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