Announcement

  • Announcement also available in Portable Document Format (PDF)

Children and Youth Evaluation Services (C-YES) Transition
Case Transfer Expectations for Health Homes Serving Children

To: Health Homes Serving Children (HHSC)

Date: January 30, 2026

As previously announced, effective April 1, 2026, Maximus will no longer provide Children and Youth Evaluation Services (C-YES). Children's Waiver participants working with

Maximus C-YES are required to be transitioned to the Health Home program and Care Management service no later than March 31, 2026. There are approximately 100 Children's Waiver participants statewide who are impacted by this transition.

The State is issuing the following guidance, to support a consistent, timely, and coordinated transfer of Children's Waiver participants from Maximus C-YES to Health Homes:

I. Required Documentation

All Transfers from Maximus C-YES to Health Homes will be completed following the Transfer Process between C-YES and Health Home Serving Children (HHSC) policy. As part of the transfer, Health Homes will receive:

  • The C-YES Opt-in to Health Home form, which documents the participant's family's agreement to enroll in Health Home and authorizes the transfer of all necessary information.
  • The Transfer Form for C-YES, Health Homes, and Care Management Agencies, on which Maximus C-YES will denote whether the transfer request is due to C-YES closure and other notable information, e.g., OPWDD interest.
  • Relevant documentation to support the participant's enrollment into the Children's Waiver and ongoing care coordination needs.
  • During this transition period, the Department is waiving the "Warm Hand-Off" requirement from Maximus C-YES to the Health Home.
    • In cases in which the Health Home CMA has already met the participant/family and is providing services, a "Warm Hand-Off" between Maximus and the HH/CMA is not appropriate.
    • If the receiving Health Home, CMA, or Maximus C-YES determines a "Warm Hand-Off" is necessary due to the specific needs of the participant or family and important to the transfer, then the "Warm Hand-Off" should occur.
II. Case Acceptance and Transition Expectation

Health Homes are required to work with their network CMAs to determine their capacity to accept Children's Waiver enrolled participants transferred from Maximus C-YES. Health Homes must prioritize Maximus C-YES transfer cases over community referrals and report to the Department at IndependentEntity@health.ny.gov within three (3) business days if the Health Home does not have capacity to accept the transfer. Participants who are HCBS eligible and enrolled may not be on a waitlist for care coordination. The State will monitor compliance and address delays.

If the documentation provided by Maximus C-YES is incomplete, the receiving Health Home must reach out to Maximus C-YES and the Department at IndependentEntity@health.ny.gov describing the missing information within one (1) business days from the transfer request. If Maximus C-YES has been unable to obtain certain types of documentation that is delaying the transfer to the Health Home program, Maximus C-YES may still transfer the case, and the HH may accept the transfer, without the documentation. These documents include the Freedom of Choice form (the Health Home will complete when meeting with the member), the C-YES Opt-in to Health Home form, and documentation of Health Home/CMA choice.

The Health Home should verify the child is enrolled in the Children's Waiver and has the proper K-codes on the Medicaid file. Health Homes are not responsible for verifying the appropriateness of Maximus C-YES Children's Waiver eligibility determinations or case record documentation to support the eligibility determination. Health Homes are only responsible for maintaining supporting documentation for Children's Waiver eligibility determinations they conduct.

The HH must verify the necessary documentation and the appropriate K-codes on the Medicaid file and accept transfer cases within three (3) business days from the transfer request date. Once the Health Home has accepted the transfer, Maximus C-YES will close the case.

The HH/CMA/Maximus C-YES must determine whether a "Warm Hand-Off" is necessary within the three (3) business days from the transfer request date. The Health Home and Maximus C-YES must schedule the "Warm Hand-Off" appointment as soon as possible, but no later than ten (10) business days from the date of the transfer request.

To summarize, from the date of the transfer request:

  • Within one (1) business day, the HH/CMA must determine whether any documentation necessary to complete the transfer is missing and contact CYES and the Department requesting the missing information.
  • Within three (3) business days
    • Indicate to the Department if the HH does not have capacity to accept the transfer.
      OR
    • If the HH has capacity, the HH must verify the appropriate K codes on the participant's record, accept the transfer, and determine whether a "Warm Hand-Off" is necessary.
  • Within ten (10) business days
    • The HH/CMA and Maximus C-YES will schedule the "Warm Hand-Off", if needed. C-YES will close the case when the "Warm Hand-Off" is complete.
III. Transition Tracking and Monitoring

The Department will closely monitor progress of the transfers to ensure successful transfers of all impacted participants by March 31, 2026.

  • The Department has provided the Health Homes an initial Maximus C-YES transfer list and required the Health Homes to update the status of each case.
  • The Department will respond to the Health Home and Maximus C-YES to any outstanding issue to ensure a successful and timely transfer.
  • Each week, if there are changes to the transfer list pending, the Department will update the original Maximus C-YES transfer list with the additional transfers for the Health Home denoted by Maximus C-YES and send it to the Health Homes to update the status of each case.
IV. Participant/Family Education Requirements

To support this transition, Maximus C-YES will add information to the "Any relevant notes or documents other than listed above" text box on page #6 of the Transfer Form for C-YES, Health Homes, and Care Management Agencies to identify the reason for case transfer and other information for the Health Home to be aware of:

  • Family Choice: The case is being transferred because the participant/family has determined that Health Home Care Management is the best fit for their needs. The participant/family is interested in receiving Health Home Care Management services.
  • Program Transition: The case is being transferred due to closure of the Maximus C-YES program. The participant/family may have previously opt-ed out of Health Home Care Management.
  • OPWDD Interest: The child/family has indicated that they would like to go to OPWDD for waiver, services, and or a provider.
  • EMod/VMod/AAT Interest: The child/family has indicated that they would need or want a modification or assistive technology.
  • Pending/Missing Documentation: Whether Maximus C-YES is unable to obtain certain documentation typically provided for a transfer, e.g. Freedom of Choice form.
  • Other: Describe any additional critical information not already captured on the form that the care manager may need related to the participant's care and services.

Questions regarding this announcement or the C-YES transition generally may be directed to IndependentEntity@health.ny.gov.