HCBS Eligibility

What are the requirements for HCBS Eligibility?

The HCBS program requires the following criteria for eligibility:
1. Children/youth aged 0-21;
2. Applicant must be actively enrolled in Medicaid;
3. Applicant must be a resident of New York State;
4. Applicant must have a qualifying medical or mental health condition. 

Any one of the following 5 scenarios would make a child eligible to receive HCBS:
1.  Medically Fragile (Children with SSI or Disability Certificate or who qualify for those)

2. Developmental Disability and are Medically Fragile

3. Developmental Disability and are in Foster Care

4. Have an SED (Serious Emotional Disturbance) AND be at imminent risk - Either be at risk of or
applied for or recently been in out of home placement (e.g. psychiatric hospital) - in the past 6 months.

5. Have an SED (Serious Emotional Disturbance) AND multi-system involvement as defined below (see next section)

Multi-System Involvement:
(must be receiving clinical services and one additional service)

 

Clinical Services: clinic and treatment services for behavioral health (therapy, counseling, medication, OMH)
Plus one of the following systems:

School: have an established IEP or 504 plan to address an identified disability or impairment which is
impacting the child's success in the school environment

Child Welfare: Child Protective Services, preventive services, or foster care

Juvenile Justice: arrest, PINS petition, Aftercare, Probation, or Parole

Department of Homeless Services: preventive services, housing assistance services or in a shelter

OASAS: In receipt of a service/s for a diagnosed substance use need by a certified OASAS
provider/program