New York State High Fidelity Wraparound Child/Family Enrollment Criteria
ARCHIVED February 2025
- Criteria also available in Portable Document Format (PDF)
To qualify for enrollment in care management using High Fidelity Wraparound, a child or youth must be determined:
- ➢ Health Home eligible by the New York State Health Home Serving Children (HHSC) criteria under the single qualifying condition of Serious Emotional Disturbance, including enrollment in Medicaid.
OR - ➢ Health Home eligible by New York State HHSC criteria under the single qualifying condition of Serious Emotional Disturbance, but Medicaid-ineligible and cannot enroll in Health Home.
AND must meet the following criteria:
- ➢ Be between the ages of 5 and 21 (attaining at least the 5th birthday but not the 21st birthday at the time of enrollment); AND
- ➢ Live in the community, in a designated county or designated borough of New York City in settings allowable by Health Home guidelines. Child/youth may be at imminent discharge from out-of-home or out-of-state care and treatment at the time of New York State System of Care (SOC) referral, when engagement may begin 30 days before discharge; AND
- ➢ Be willing to participate in the New York State SOC Pilot using High Fidelity Wraparound practice; AND
- ➢ Is in receipt of behavioral health-oriented services and/or involved with two or more child-serving systems (e.g., health, child welfare, education supports and/or special education services, juvenile justice, mental health and/or addiction services/supports) in the six months; AND
- ➢ Has a CANS-NY Health Home score of high acuity;
AND demonstrates documented evidence of (at least one):
- Being at emerging/imminent risk of out-of-home care and treatment due to challenges living in the home or community; OR
- Returning to home and community from out-of-home care and treatment; OR
- Inpatient hospitalization (mental health, substance use or physical health) within the past six months;
OR - Multiple responses in the last 6-12 months by or engagement with community-based crisis intervention services (e.g., 911 response, emergency department visit, mobile crisis response, emergency respite stay, Home Based Crisis Intervention, Mobile Integration Team); OR
- Is at imminent risk for or has had multiple instances in the last six months of change in placement in day care, childcare, aftercare or school, including suspension or expulsion, due to significant behavioral issues related to mental health needs.
