Waivers for Children and Adolescents

Waivers for Children and Adolescents

The following waivers are designed for children and adolescents, and have an age limit for enrollment. These waivers require a transition to a new adult waiver when the child “ages out.”(29,30)

  • Care at Home Waiver I, II, III, IV, VI, up to age 18
  • Office for Mental Health HCBS Waiver for Children with Serious Emotional Disturbances, enroll up to age 18, have coverage up to age 21
  • Bridges to Health, up to age 21

Care at Home Waivers: The Medicaid waiver Care at Home (CAH) program provides community-based services to children with physical or developental disability who require hospital or skilled nursing home level of care, and allows the child to be cared for at home rather than in an institutional setting. The Care At Home Waiver program allows Medicaid to pay for some services that are not considered “medically necessary,” such as case management, respite, home adaptations and vehicle modification.

There are five levels of the Care at Home Program. Levels I and II are designed for children with physical disabilities and are operated by the NYS Department of Health; Levels III, IV, and VI are for children with developmental disabilities and are overseen by the New York State Office of People with Developmental Disabilities.

Care at Home waivers can offer a range of transitional supports and services for children up to age 18. A child’s Medicaid case can remain open so she/he can continue to receive Medicaid-covered services while their SSI determination (or the required re-determination of SSI eligibility at the age 18) is being processed. Young adults with medically fragile conditions and developmental disabilities who are enrolled in Care at Home III, IV and VI programs can seamlessly transition to the OPWDD-HCBS Adult Waiver when they “age out.”

The Office of Mental Health (OMH SED)  Home and Community-Based Services (HCBS) Waiver is designed to serve children and adolescents with serious emotional disturbances and mental health needs in their homes and communities. These children would otherwise require admission to institutional levels of care, including long term Residential Treatment Facilities and intermediate psychiatric inpatient care.

The OMH HCBS Waiver includes six services: Individual Care Coordination, Respite, Intensive In Home Services, Skill Building Services, Family Support Services and Crisis Response. Each child must have Individual Care Coordination and must be eligible for Medicaid under the HCBS Waiver in a county with a HCBS Waiver program. Details of these services can be found at NYS Office of Mental Health.

Bridges to Health: The Bridges to Health (B2H) Program provides services to children in foster care who have significant mental health, developmental disabilities, or healthcare needs, helping them to live in a home or community-based setting.

From the NYS DOH: “B2H is administered as three separate targeted 1915(c) Medicaid waivers providing Medicaid State Plan services, and the following waiver services: ’Health Care Integration, Skill building, Family caregiver supports and services, Day habilitation, Prevocational services, Supported employment, Planned respite, Special needs community k  advocacy and support, Crisis avoidance, management and training, Immediate crisis response services, Intensive in-home supports crisis respite, Accessibility modifications and Adaptive and Assistive equipment.”

The Office of Children and Family Services operates the following three waivers as a single B2H Program:

  • B2H for children with Serious Emotional Disturbances (SED)
  • B2H for children with Developmental Disabilities (DD)
  • B2H for children with Medical Fragility (Med F)

(For more detailed descriptions, please go to: Office of Children & Family Services)

Bridges to Health requires transition planning with a case manager at the local departments of social services. For youth enrolled in the Bridges to Health waiver, the case manager develops a transition plan at least 18 months prior to the 21st birthday. The case manager is required to identify all Medicaid-covered and other services the young adult needs, assess the young adult’s eligibility for adult services, and facilitate his or her transition to appropriate services.