Notification of Changes to Care Management Services for the Children's Waiver Announcement

  • Notification also available in Portable Document Format (PDF)

Notification of Changes to Care Management Services for the Children's Waiver

To: Children's Home and Community Based Service (HCBS) Waiver Providers, Health Homes Serving Children, Care Management Agencies, and Medicaid Managed Care Plans (MMCPs) including Mainstream Managed Care and HIV Special Needs Plans

Date: December 5, 2025

This notice is to inform the Children's Waiver HCBS providers, Health Homes and Care Management Agencies serving children, and MMCPs of changes to care management services for Children's Waiver participants. Since the launch of the 1915(c) Children's Waiver, eligible and enrolled participants have had a choice of obtaining their Waiver care management services provided by either the Health Home or the Independent Entity, Children and Youth Evaluation Services (C-YES). Effective January 1, 2026, under a pending 1915c Waiver Amendment, to be approved by the Center for Medicare and Medicaid Services (CMS) all Children's Waiver participants will receive care management services from a Health Home. Children currently receiving care management services through C-YES will transition to a Health Home beginning January 1, 2026, and not later than March 31, 2026. In addition, the New York State Department of Health (Department) or Office of Mental Health (OMH) will conduct Children's Waiver eligibility determinations for children/youth who are not already enrolled in Medicaid and may need Children's Waiver services beginning January 1, 2026.

There will be a three-month transition period from January 1, 2026, through March 31, 2026. During this time, C-YES will transition Children's Waiver enrollees to a Health Home care management provider and assist with the completion of the eligibility process for children referred to C-YES for a Children's Waiver eligibility assessment on or before December 31, 2025.

Key updates related to this change are provided below:

  • C-YES will continue to support children/youth who have an HCBS eligibility determination in-progress on or before December 31, 2025, until completion. Once complete C-YES will work to transition the participant to a Health Home for ongoing care management.
  • All Children's Waiver participants will continue to receive care management and choose a Health Home Care Management Agency during the transition period. Participants that previously opted out of Health Home care management and currently receive Waiver care management services through C-YES and/or their MMCP, must be transitioned to a Health Home/Care Management Agency by March 31, 2026. Transfers will occur following the standard C-YES to Health Home transfer process as outlined in the Transfer Process between the C-YES and Health Home Serving Children (HHSC) Policy.
  • Effective January 1, 2026, the Department or OMH will be responsible for determining initial Children's Waiver eligibility for children/youth not already enrolled in Medicaid. Once found eligible and enrolled in the Waiver and Medicaid, these participants will be transferred to a Health Home for ongoing care management. An annual HCBS eligibility re-determination will be completed as needed.
  • Children/youth already enrolled in Medicaid who may need Children's Waiver services will be referred to Health Homes for the Children's Waiver eligibility determination. The Department/OMH will only support children/youth not already Medicaid enrolled through the initial HCBS eligibility and Medicaid enrollment process.
  • Prior to January 1, 2026, if any children/youth enrolled in Health Home Care Management express interest in transferring to C-YES, they must be informed about these upcoming care management changes. If a family transfers to C-YES prior to January 1, 2026, they will be required to transfer back to Health Home by March 31, 2026.
  • Additional information including contact information for State operated C-YES functionality will be shared before January 1, 2026.

In preparation for this transition, C-YES will outreach to families about this update and educate them about their options for care management provided by Health Homes.

Additionally, C-YES will outreach to Health Homes to initiate the transfer process of participants from C-YES to Health Home. HHSC and MMCPs are asked to begin to coordinate and collaborate with C-YES to ensure an efficient transfer of enrollees no later than March 31, 2026.

Questions on this update can be directed to BH.Transition@health.ny.gov.