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Office of Mental Health

Home and Community Based Services Waiver
Guidance Document
Division of Children and Families

500.1

HCBS Waiver Enrollment Eligibility Criteria

Eligibility for the OMH HCBS Waiver is "3-pronged". A child who applies for the Waiver must meet three sets of eligibility criteria, i.e. clinical, Medicaid, and fiscal. The applicant must be found eligible in all three areas. Ineligibility in one area makes the applicant ineligible for the Waiver.

  1. Clinical Requirements

    To meet the clinical eligibility requirements, a child or 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 date of enrollment; the child can be served in Waiver until s/he turns 21, however, s/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.

    Who Determines: Clinical eligibility is determined by the Local Governmental Unit (LGU) representative.

  2. Medicaid Requirements

    The requirements for Medicaid eligibility that must be met under the OMH HCBS Waiver are:

  1. Fiscal Requirements

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

    Who Determines: Fiscal eligibility is determined by the Local Governmental Unit (LGU) representative.

Enrollment Considerations

Operations Support Unit (OSU)

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.