Concurrent 1915(c) Children’s Waiver and 1115 Waiver Amendments

The State has been working with CMS to implement the Children’s Medicaid System Transformation. On May 9, 2017, the State submitted to CMS a proposed 1115 Waiver Amendment and on November 14, 2017, the State submitted to CMS a Draft Transition Plan (which included comments from stakeholders) to implement the proposed 1115 Waiver Amendment. In April 2018, the State submitted to CMS a revised 1115 Waiver Amendment (April 24, 2018) and a revised Draft Transition Plan (April 30, 2018) to reflect changes to the timeline for implementing the Children’s Medicaid System Transformation. On June 21, 2018, CMS advised the State that 1915 waiver vehicles, rather than the sole use of the 1115 Waiver Amendment, must be used to implement the Children’s Medicaid System Transformation. As a result, the State is now proposing the Children’s Medicaid System Transformation be implemented under concurrent 1915(c) waiver and 1115 waiver amendments.

The proposed concurrent 1915(c) and 1115 waiver amendments, and timelines for implementation, are subject to CMS approvals and thus may be subject to further modification.

A draft of the 1915(c) Children’s Waiver is being made available for stakeholder comment and is available at the link below. Comments on the draft 1915(c) Children’s Waiver are due September 23, 2018 and can be submitted to BH.transition@health.ny.gov. Please indicate “1915(c) Children’s Waiver Comments” in the subject of the email. No programmatic changes (only the authorities requested to implement the Children’s Transformation) are being proposed to the 1115 Waiver amendments, and prior versions of the waiver submitted on May 9, 2017 and April 24, 2018 are available at the links below. The draft Transition Plan, has been updated to reflect the use of a concurrent 1915(c) Children’s Waiver and 1115 Waiver Amendment to implement the Children’s Medicaid Transformation and is available at the link below. No significant programmatic changes have been made to the Transition Plan.

Overview of Concurrent 1915(c) Children’s Waiver and 1115 Waivers

Effective no earlier than April 1, 2019, the following six 1915(c) Home and Community Based Services (HCBS) waivers will be consolidated into a single, 1915(c) Children’s Waiver:

  • Office of Mental Health (OMH) Serious Emotional Disturbance (SED) waiver #NY.0296;
  • Department of Health (DOH) Care at Home (CAH) I/II waiver #NY.4125;
  • Office for People with Developmental Disabilities (OPWDD) Care at Home waiver #40176; and
  • Office of Children and Families (OCFS) Bridges to Health (B2H) SED waiver #NY.0469, B2H Developmental Disability (DD) waiver #NY.0470, and B2H Medically Fragile waiver #NY.0471.

The 1915(c) Children’s Waiver will:

  • Streamline the children’s HCBS administration to have more consistent eligibility processes and benefits across all populations.
  • Provide a single HCBS benefit package to children meeting institutional level of care (LOC) functional criteria. Over a three-year period, eliminate the use of waiting lists related to HCBS capacity under the waiver. All of the HCBS services authorized under the six current 1915(c) children’s waivers will continue to be authorized as either an HCBS authorized under the 1915(c) Children’s Waiver or a new State Plan service.
  • Provide Health Home care management to children eligible for HCBS and an administrative alternative for children that may opt of Health Home. Children currently enrolled in one of the six 1915(c) waivers will begin to transition to Health Home no earlier than January 1, 2019.

The 1115 waiver, which will be implemented concurrently with the 1915(c) Children’s Waiver will:

  • Incorporate certain Medicaid State Plan behavioral health services into the MMMC and HIV SNP contracts for enrolled children.
  • Include newly aligned HCBS authorized under the concurrent 1915(c) Children’s Waiver in the managed care benefit package.
  • Remove the exemption from mandatory enrollment into MMMC and HIV SNPS for children in the 1915(c) Children’s Waiver, unless the child is otherwise exempt or excluded from enrollment (i.e., available comprehensive Third Party Health Insurance and/or Medicare, or Medically Needy child who is provisionally eligible). Children who are otherwise exempt or excluded from enrollment into MMMC and enrolled in 1915(c) Children’s waiver will remain in, or receive FFS Medicaid, including HCBS, until those exemptions or exclusions from MMMC and HIV SNP enrollment are removed.
  • Offer State Plan CFCO services to LOC children eligible for Medicaid solely because of receipt of HCBS services (i.e., Family-of-One children not eligible under the State Plan but who meet institutional admission criteria and receive HCBS services).
  • No earlier than July 2019, remove the exclusion from MMMC enrollment for children in the care of a voluntary foster care agency, and include Residential Supports and Services (to be authorized under a separate State Plan Amendment) in MMC benefit package.
  • Authorize transitional rates for waiver providers under six children’s 1915(c) waivers that will transition from waiver care management rates to Health Home rates. Provide conflict free case management for children receiving HCBS and Health Home care management.
  • Authorize Family Peer, Youth Peer, and Crisis Intervention to HCBS eligible children between April 1, 2019 and the dates those services become State Plan services (July 1, 2019 for peer and January 1, 2020 for Youth and Crisis).
  • No earlier than 2022, expand Medicaid services to offer an HCBS benefit package identical to the 1115 HCBS package (but not including State Plan CFCO services) to children that meet targeting criteria and having functional needs at-risk of institutional care under the Demonstration, i.e., “at-risk” HCBS Level of Need (LON) services.