HCBS Eligibility, Services, and Plan of Care (POC)
Policy
- HCBS Service Definition and Necessity Criteria Policy #CW0020 - May 16, 2025
- Health Home Plan of Care Policy #HH0008 - Updated December 2024
- Guide to Edits for Health Home Plan of Care Policy #HH0008 (PDF) - Updated December 2024
- Health Homes Serving Children - 10 Elements of a Plan of Care - January 2024
- Children's HCBS POC Workflow Policy #CW0002 - Updated May 2022
- Children's Home and Community Based Services (HCBS) Waiver Eligibility and Enrollment Policy #CW0005 - March 2024
Guidance
- Guidance Update - Annual HCBS Eligibility Requirements when Fair Hearing w/ Aid Continuing - March 2026
- Clarification - Children's Waiver Home and Community Based Services (HCBS) Recipient Restriction/Exemption (R/RE) K-Codes for Eligibility and Enrollment Announcement - March 28, 2025
- Update on Children's Waiver HCBS Referrals for Children/Youth Who Opt-Out of Health Home Announcement - December 17, 2024
- Reminder: Children's Home and Community Based Services Medically Fragile and Serious Emotional Disturbance Target Population Announcement - December 6, 2024
- GIS 24 MA-04 - Medically Fragile or Developmentally Disabled and Medically Fragile Consumers enrolled in the 1915(c) Children's Waiver and County Single Point of Access (C-SPOA) role (PDF) - June 3, 2024
- Medically Fragile Children's Waiver Eligibility Determination FAQ
- SED Children's Waiver Eligibility FAQ
- Extension of Deadline to Obtain Disability Determinations for Medically Fragile Children's Waiver Members Announcement - October 31, 2023
- Children's HCBS Medicaid Managed Care Plan Transfer Continuity of Care Requirements - September 5, 2023
- UPDATE: Changes to the Disability Documentation Process for the 1915c Children's Waiver Announcement - July 27, 2023
- Guidance Regarding the Medically Fragile Disability Determination Requirement - April 2023
- Clarification Guidance Re: Children's Waiver HCBS Serious Emotional Disturbance (SED) Eligibility Determination Requirements - April 2023
- Updated LPHA Guidance and Instructions - July 29, 2022
- Children's HCBS POC Workflow FAQ - Updated May 2022
- Reminder Regarding Children's HCBS Billing and Claiming Requirements (PDF) - April 4, 2022
- HCBS POC Workflow Policy Requirement Reminder (PDF) - November 2020
- HCBS POC Workflow DESK AID, Roles and Responsibilities (PDF) - October 2020
- REMINDER for HCBS PROVIDERS: Children's HCBS Authorization Form and Communication with MMCP (PDF) - March 2020
- Services Access Documentation (PDF) - March 2019
- Person Centered Service Planning Guidelines (PDF) - December 19, 2018
Webinars
- HCBS Referral Process - Reminders, Best Practices, and Updates Webinar (PDF) | Recording (YouTube) - October 20, 2025
- HCBS Service Definitions and Necessity Criteria Policy Pt.4 Webinar (PDF) | Recording (YouTube) - June 30, 2025
- HCBS Service Definitions and Necessity Criteria Policy Pt.3 Webinar (PDF) | Recording (YouTube) - June 16, 2025
- HCBS Service Definitions and Necessity Criteria Policy Pt.2 Webinar (PDF) | Recording (YouTube) - June 10, 2025
- HCBS Service Definitions and Necessity Criteria Policy Pt.1 Webinar (PDF) | Recording (YouTube) - June 5, 2025
- Children'S Waiver HCBS Fee-For-Service Authorization Webinar (PDF) | Recording (YouTube) - January 24, 2025
- HCBS Service Referral Process & Expectations Webinar (PDF) | Recording (YouTube) - October 2024
- Considerations for Determining HCBS Eligibility for the Serious Emotional Disturbance (SED) Target Population Webinar | Recording (YouTube) - April 19, 2023
- Updates and Clarification Regarding:
- Health & Safety Planning Requirements for the Children's Waiver webinar slides (PDF) | Recording (YouTube) - September 2021
- Children's HCBS Planning and Plan of Care Development Webinar (External Link) - April 3, 2019
- Webinar and Discussion with HCBS Providers regarding HCBS POC Workflow (PDF) - October 2020
- Webinar: Children's HCBS POC Workflow & MMCP Service Authorization for HCBS Providers (PDF) - October 18, 2019
- Children's HCBS POC Workflow Webinar (PDF) | Recording (YouTube) - August 28, 2019
Resources
Forms
HCBS LPHA Attestation Forms
- Serious Emotional Disturbance (SED) LPHA Attestation Form
- DOH-5275 (PDF) - updated May 2023
- Guide to Edits - May 2023
Freedom of Choice Form
Medically Fragile Target Population Forms
- Disability Review Team Certificate - DOH 5144 (PDF)
- Childhood Medical Disability Report - DOH-5151 (PDF)
- Questionnaire of School Performance - DOH-5152 (PDF)
- Description of Child's Activities - DOH-5153 (PDF)
- Disability Questionnaire - DOH-5139 (PDF)
- Authorization for Release of Health Information Pursuant to HIPAA - DOH 5173 (PDF)
Notice of Decision Forms
Form DOH-5287
DOH-5287 Notice of Decision For Enrollment or Denial of Enrollment in the New York State 1915(c) Children's Waiver - Updated October 2024
Form DOH-5288
DOH-5288 Notice of Decision For Discontinuance in the New York State 1915(c) Children's Waiver - Updated October 2024
Participant Rights and Responsibilities
