Do you know the criteria for a child’s eligibility for HCBS?

The following is from the New York State Office of Mental Health (OMH) website, which clearly defines the target population of the HCBS Waiver for children. 

The target population for the HCBS Waiver is children/adolescents:

  • with serious emotional disturbance,
  • between the ages of 5 and 17 years (prior to 18th birthday),
  • who demonstrate complex health and mental health needs,
  • who are at imminent risk of admission to a psychiatric institutional level of care or have a need for continued psychiatric hospitalization, 
  • whose service and support needs cannot be met by just one agency/system,
  • who are capable of being cared for in the home and/or community if services are provided,
  • who have a viable and consistent living environment with parents/guardians who are able and willing to participate in the HCBS Waiver, and
  • who can reasonably be expected to be served under the HCBS Waiver at a cost which does not exceed that of psychiatric institutional care.

They must be eligible for Medicaid under the HCBS Waiver (i.e., are currently enrolled in Medicaid or could be enrolled by meeting federal eligibility standards) in a county with an HCBS Waiver program and be capable of being served in the community at or below the federally approved average yearly cost which is adjusted periodically.

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

SAE’s financial modeling service can help determine risk and ramp up of these new services based upon your agency’s current service populations and activities. To learn more about this support service product, check out our recent announcement here: