NYS OMH’s Need-to-Knows on Home and Community-Based Services Waivers for Children

The New York State Office of Mental Health (OMH) has posted its HCBS Waiver Guidance Document for Children on its website. According to OMH, a child has to meet all clinical, Medicaid, and fiscal requirements to be eligible for the OMH Home and Community-Based Services Waiver. Ineligibility in just one area makes the child applicant ineligible for the Waiver.

The following is from the OMH website (https://www.omh.ny.gov/), which details the requirements for each of the three sets of criteria that the child must meet.

Clinical Requirements

A child/adolescent applying for the OMH HCBS Waiver must:

  • have a serious emotional disturbance (SED);
  • be between the ages of 5 and 18 on the effective enrollment date; the child can be served in Waiver until she/he turns 21, however she/he must be enrolled prior to his/her 18th birthday;
  • demonstrate complex health and mental health needs;
  • require institutional level of care;
  • be at imminent risk of admission to an institutional level of care or must have a need for continued psychiatric hospitalization;
  • have service and support needs that can not be met by just one agency/system;
  • be capable of being cared for in the home and/or community if Waiver services are provided; and
  • have a viable and consistent living environment with parents/guardians who are able and willing to participate in the HCBS Waiver and support the child in the home and community.

Medicaid Requirements

  • The child/adolescent must meet all federal categorical criteria for eligibility, e.g. she/he  must be a US citizen or meet the definition of “qualified alien” to be eligible for Medicaid.
  • The child/adolescent’s own income and resources, after deducting applicable disregards and exemptions, should be less than the current Medicaid income Exemption Standard for a family of one. If it is not, effective January 1, 2009, a spend-down process may be initiated.
  • Only the child/adolescent’s own income and resources are taken into consideration. The parents’ income and resources aren’t counted due to the waiver of parental deeming.
  • The child’s Medicaid coverage must be in a county that is participating in the OMH HCBS Waiver.
  • In accordance to NYS Department of Health Directive GIS MA 14/27; December 2014, all Medicaid applications for individuals in need of waiver services are to be processed by the local district (LDSS/NYC-HRA), and not by means of the New York State of Health (Health Benefits Exchange). In most cases, the OMH Operations Support Unit (OSU) will notify Waiver providers that the actions noted below must be taken for an individual that has been found to be in receipt of New York State of Health (NYSoH) Medicaid coverage. However, if Waiver program staff discovers NYSoH Medicaid coverage in the early stages of enrollment, the procedures noted below may be proactively executed to maximize the timeliness of the transition from NYSoH to local LDSS/NYC-HRA which is necessary in order for Waiver enrollment to occur. 

Fiscal Requirements

  • To be fiscally eligible for the OMH HCBS Waiver, a child/adolescent must be capable of being erved in the community within the federally-approved cost of institutional care and within NYS OMH and Division of the Budget approved caps. A project annualized budget is included in every service plan for each child.

Click the following link to view OMH’s HCBS Waiver Guidance Document in its entirety: