What is your child’s age?
Does your child currently have Medi-Cal?
Yes, through the Medi-Cal waiver
Is your child a Regional Center client?
Select your current Regional Center:
Do you or your child’s doctor have concerns in any of the following areas of development?
Social: emotions, interacting with others
Adaptive: daily activities such as dressing
Physical: large and small movements
Communication: pre-speech and language
Cognitive: thinking and problem-solving
Do any of the below apply to your child?
Prematurity of < 32 weeks gestation and/or low birth weight
Assisted ventilation of >48 hours during the first 28 days of life
Prenatal substance exposure
Does your child have any of the following qualifying diagnoses?
Other condition closely related to intellectual disability or requiring similar treatment
How are you using Medi-Cal?
Secondary insurance (e.g., co-pays not covered by private insurance)
Has your private insurance denied any of the following?
Durable medical equipment
Skilled nursing (G-tube, trach, etc.)
Incontinence supplies (after age 3)
What is your annual out-of-pocket cost (approximate)?
Who is your primary insurance provider?
Do you receive In-Home Supportive Services (IHSS)?
In the process of applying
Do you receive protective supervision?
How many IHSS hours do you receive per month?
Who is the IHSS caretaker for your child?
I am the only caretaker
We have one non-family member caretaker
We have multiple non-family caretakers
How can Undivided help you get the care you need for your child?
Should be Empty: