Overview of 1915c Children’s Waiver and 1115 Waiver
Any questions surrounding the implementation of the Children’s Medicaid System Transformation can be sent to BH.Transition@health.ny.gov
Overview of 1915(c) Children’s Waiver and 1115 Waiver
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.
- 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).
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.
- 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.
1915c Children’s Waiver Amendment
- Approved Effective December 1, 2021 HCBS Waiver Application NY 4125 R05.11 – December 2021 (PDF)
- Effective Changes to the Children’s Waiver of Home and Community Based Services (HCBS) and Children and Family Treatment and Support Services (CFTSS) – April 2020 (PDF)
- New York State Register July 15, 2020 Volume XLII Volume 28
- Approved Effective December 1, 2020 HCBS Waiver Application NY 4125 R05.09 – December 2020 (PDF)
- Approved Effective March 15, 2020 HCBS Waiver Application NY 4125 R05.05 – March 2020 (PDF)
- Approved Effective October 1, 2019 HCBS Waiver Application NY 4125 R05.06 – October 2019 (PDF)
- Approved Effective August 1, 2019 HCBS Waiver Application NY 4125 R05.02 – August 2019 (PDF)
1115 Waiver Amendment
- Children’s Design Interim Evaluation – (PDF) submitted to CMS July 2021
- Children's 1115 Evaluation Design Approval Letter – April 2020 (PDF)
- Approved Children's 1115 Evaluation Design – April 2020 (PDF)
- Approved 1115 Demonstration Project Number 11-W-001142/2 Effective August 2, 2019
- Children’s 1115 Waiver Amendment – April 2018 (PDF)
- Children’s 1115 Waiver Amendment – May 2017 (PDF)
Amendment and Evaluation
COVID-19 Response and Guidance
- COVID-19 Guidance for Children’s Waiver Health Home Care Management Agencies, C-YES, HCBS Providers, and MMCP/HIV SNP – March 14, 2020 (Updated June 2021) (PDF)
- COVID-19 Guidance for Children's Waiver Services Providers – March 14, 2020 (Updated June 2021) (PDF)
- COVID-19 Guidance for Designated Children and Family Treatment and Support Services' Providers – March 19, 2020 (Updated June 2021) (PDF)
- COVID-19 HCBS Respite Guidance – April 8, 2020 (Updated June 2021) (PDF)
- CMS APPROVED 1915c Children Waiver Appendix K Amendment for COVID-19 - Extended Effective Dates – March 2021 (PDF)
- CMS APPROVED Second Appendix K for COVID-19 – Retainer Payment – September 2020 (PDF)
- COVID-19 Guidance for Children’s Waiver Service Providers – Billing and soft CAPs – March 14, 2020 (Updated June 10, 2020) (PDF)
- CMS APPROVED 1915c Children Waiver Appendix K Amendment for COVID-19 – June 2020 (PDF)
- COVID-19 Children’s Waiver HCBS/LOC Ineligible Clarification – October 2020 (PDF)
- FAQ to Address Appendix K COVID-19 Questions – Updated August 26, 2020 (PDF)
- Elements of the Approved Appendix K – August 6, 2020 (PDF)
- Draft Effective September 1, 2021 HCBS Waiver Application NY.019.05.11 – September 2021 (PDF)
- Public Notice: Draft Effective September 1, 2021 HCBS Waiver Application NY.019.05.11 – April 2021
- Proposed Amendment Changes to HCBS Waiver Application NY 4125 R05.07 (PDF) – March 2020
- Proposed Amendment Changes to HCBS Waiver Application NY 4125 R05.02 for August 2019 (PDF) – July 2019
- APPROVED Effective April 1, 2019 HCBS Waiver Application NY 4125 R05.02 (PDF) – April 1, 2019
- 1915c Children’s Waiver Stakeholder feedback (PDF) – October 18, 2018