The New York State Department of Health Announces Approval of Federal Medicaid Waiver to Improve Access to Care for Children with Complex Health Needs

Expanded Home- and Community-Based Services Now Billable to Medicaid

More than 6,000 Children Will Benefit

ALBANY, NY (August 6, 2019) – The New York State Department of Health today announced that a proposal for a new Medicaid model of care serving children throughout the state with complex health needs has been approved by the federal Centers for Medicare and Medicaid Services (CMS). The new streamlined care model will improve access to Medicaid services and expand Medicaid coverage to home- and community-based care for more than 6,000 youth under age 21 who are faced with an array of serious health issues and otherwise could be forced to live in hospitals and other institutionalized settings.

"Expanding coverage of community-based and at-home healthcare services will allow children throughout the state to receive necessary services while remaining at home and in their communities," said Commissioner of the New York State Department of Health Dr. Howard Zucker. "New York State's Medicaid program continues to expand under Governor Cuomo's leadership, while we explore innovative healthcare delivery models that cut costs and improve outcomes."

"Children who are involved with the child welfare system often have complex medical and behavioral health needs," said Office of Children and Family Services Commissioner Sheila J. Poole. "We look forward to the opportunity this transition will bring to youth in foster care and will continue to work in collaboration with our partner state agencies, local departments of social services and voluntary agencies to make families aware of newly available services and how they can tailor the way those services are delivered to best meet their individual needs. We are hopeful that these new services will make a difference in the lives of children and their families."

The proposal, developed by the Medicaid Redesign Team's Children's Subcommittee, maximizes the efficiency of coordinated care management by allowing managed care plans to provide home- and community-based services to the following:

  • Medically fragile children,
  • Children with a behavioral health diagnosis,
  • Children with a serious emotional disturbance (SED),
  • Children with developmental disabilities, and
  • Children in foster care.

Services to this population encompass an umbrella of various supports, including:

  • assistance with the development and improvement of daily life skills,
  • providing equipment or systems that increase functional capabilities, and
  • delivery of specialized medical care for a serious illness.

With the introduction of this streamlined children's managed care model, New York State aims to improve clinical and recovery outcomes for children with complex needs; reduce health care costs by preventing unnecessary emergency and inpatient care; address needs before they escalate and become more costly and complex; integrate the delivery and care planning of behavioral health, health services and community supports; and increase network capacity to deliver community-based recovery-oriented services and supports.

Other components of this new care model include Health Home care management and the addition of six new behavioral health services covered by Medicaid, to be phased in over time.

The new care model also updates enrollment requirements for children with disabilities receiving home- and community-based services. The new model also includes safeguards giving children equal access to services based upon need. In addition, delivery of services has been consolidated under a single program to ensure that the services are available to all children in need of complex care.