• Children's Home and Community Based Services (HCBS) Waiver Eligibility and Enrollment Policy #CW0005 - (Web) - (PDF) - March 2024

• Medically Fragile Children's Waiver Eligibility Determination FAQ - (Web) - (PDF)
• SED Children's Waiver Eligibility FAQ - (Web) - (PDF)
• 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
• Extension of Deadline to Obtain Disability Determinations for Medically Fragile Children's Waiver Members - (Web) - (PDF) - October 31, 2023
• UPDATE: Changes to the Disability Documentation Process for the 1915c Children's Waiver - (PDF) - July 27, 2023
• Guidance Regarding the Medically Fragile Disability Determination Requirement - (Web) - (PDF) - April 2023
• Clarification Guidance Re: Children's Waiver HCBS Serious Emotional Disturbance (SED) Eligibility Determination Requirements - (Web) - (PDF) - April 2023
• Updated LPHA Guidance and Instructions - (Web) - (PDF) - July 29, 2022

• Considerations for Determining HCBS Eligibility for the Serious Emotional Disturbance (SED) Target Population - (Web) - (PDF) - (Recording) - April 19, 2023
• Updates and Clarification Regarding:
  • Medically Fragile (MF) Population HCBS LOC Determination: - (Web) - (PDF) - (Recording) - April 6, 2023
  • Serious Emotional Disturbance (SED) Target Population HCBS LOC Eligibility Determination - (Web) - (PDF) - (Recording) - April 4, 2023

Participant Rights and Responsibilities Fact Sheet

• English (PDF)
• Bengali (PDF)
• 中文 (Chinese) (PDF)
• Kreyòl Ayisyen (Haitian-Creole) (PDF)
• 한국어 (Korean) (PDF)
• Русский (Russian) (PDF)
• Español (Spanish) (PDF)

HCBS LPHA Attestation Forms

• Serious Emotional Disturbance (SED) LPHA Attestation Form
  • DOH-5275 - updated May 2023 (PDF)
  • Guide to Edits - (Web) - (PDF) - May 2023 (PDF)

Freedom of Choice Form

DOH-5276 - Freedom of Choice - Effective October 2024

• English (PDF)
• عربى Arabic (PDF)
• Bেঙলি (Bengali) (PDF)
• Kreyòl Ayisyen (Haitian Creole) (PDF)
• Italiana (feminine), Italiano (masculine) Italian (PDF)
• 한국어 (Korean) (PDF)
• Polskie Polish (PDF)
• русский (Russian) (PDF)
• Español (Spanish) (PDF)
• 繁體中文 (Traditional Chinese) (PDF)
• יידיש Yiddish (PDF)

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

DOH-5287 Form

Notice of Decision For Enrollment or Denial of Enrollment in the New York State 1915(c) Children's Waiver - Updated October 2024

• English (PDF) - other translations coming soon

DOH-5288 Form

Notice of Decision For Discontinuance in the New York State 1915(c) Children's Waiver - Updated October 2024

• English (PDF) - other translations coming soon