Overview of 1915c Children's Waiver and 1115 Waiver

Any questions surrounding the implementation of the Children's Medicaid System Transformation can be sent to BH.Transition@health.ny.gov

Effective on April 1, 2019, the following six 1915(c) Home and Community Based Services (HCBS) waivers have been consolidated into a single, 1915(c) Children's Waiver:

  • Office of Mental Health (OMH) Serious Emotional Disturbance (SED) waiver #NY.0296;
  • Department of Health (DOH) Care at Home (CAH) I/II waiver #NY.4125;
  • Office for People with Developmental Disabilities (OPWDD) Care at Home waiver #40176; and
  • Office of Children and Families (OCFS) Bridges to Health (B2H) SED waiver #NY.0469, B2H Developmental Disability (DD) waiver #NY.0470, and B2H Medically Fragile waiver #NY.0471.

The 1915(c) Children's Waiver:

  • Streamlines the children's HCBS administration to have more consistent eligibility processes and benefits across all populations.
  • Provides a single HCBS benefit package to children meeting institutional level of care (LOC) functional criteria. The Children's Waiver also eliminated the use of waiting lists related to HCBS capacity under the waiver. All of the HCBS services authorized under the previous six 1915(c) children's waivers continue to be authorized as either an HCBS authorized under the 1915(c) Children's Waiver or a new State Plan service.
  • Provides Health Home care management to children eligible for HCBS and an administrative alternative for children that may opt of Health Home.

The 1115 waiver, which is implemented concurrently with the 1915(c) Children's Waiver:

  • Incorporates certain Medicaid State Plan behavioral health services into the MMC and HIV SNP contracts for enrolled children.
  • Includes newly aligned HCBS authorized under the concurrent 1915(c) Children's Waiver in the managed care benefit package.
  • Removes the exemption from mandatory enrollment into MMC and HIV SNPS for children in the 1915(c) Children's Waiver, unless the child is otherwise exempt or excluded from enrollment (i.e., available comprehensive Third-Party Health Insurance and/or Medicare, or Medically Needy child who is provisionally eligible). Children who are otherwise exempt or excluded from enrollment into MMC and enrolled in 1915(c) Children's waiver will remain in, or receive FFS Medicaid, including HCBS, until those exemptions or exclusions from MMC and HIV SNP enrollment are removed.
  • Removes the exclusion from MMC enrollment for children in the care of a voluntary foster care agency, and include Residential Supports and Services (authorized under a separate State Plan Amendment) in MMC benefit package.
  • Authorized transitional rates for waiver providers under six children's 1915(c) waivers that transitioned from waiver care management rates to Health Home rates. Provides conflict free case management for children receiving HCBS and Health Home care management.

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