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January/February 2025 Top of Mind
Child Health Plus now covers home and community-based services under plan benefits
Children’s Home and Community-Based (HCBS) services are now a covered benefit for youth under age 21 who are enrolled in the New York Child Health Plus (CHPlus) plan. This expanded benefit, effective Jan. 1, 2025, addresses the growing demand for specialized care for children with behavioral health needs and complex medical conditions. Reimbursement for these services will be based on published New York Medicaid rates.
Eligibility requirements
The expanded benefit coverage applies only to youth enrolled in Child Health Plus. It does not apply to youth who qualify for the Medicaid Family of One program based on their immigration or income status.
If Medicaid Family of One status is unknown: Please refer the member to C-YES at 1-833-333-CYES (1-833-333-2937)
C-YES is a statewide program that determines whether a child/youth under the age of 21 is eligible for Medicaid.
If needed, C-YES will conduct an HCBS eligibility assessment to determine if the child now meets qualifications for Medicaid Family of One.
Level of care (LOC) assessment required: Before you deliver any of the expanded benefits to a Child Health Plus member, a level of care assessment must be completed by a network (contracted) Health Home. At this time, Health Homes are getting ready to begin conducting HCBS/LOC eligibility assessments. Member will be notified when this process is in place.
What HCBS benefits are covered?
To help improve the quality and accessibility of care for children, the expanded benefits for HCBS include the following services. All require prior authorization before services are delivered.
- Adaptive and assistive technology
- Caregiver/family advocacy and support services
- Community habilitation
- Day habilitation
- Non-medical transportation
- Environmental modifications
- Supported employment
- Vehicle modifications
Palliative Care
- Expressive therapy
- Massage therapy
- Pain and symptom management
- Pre-vocational services
- Planned and crisis respite
Action Needed – Prepare your practice
You may need to enhance capabilities and update systems for your practice to meet the standards for the new specialized care. Here’s what to expect:
Updates to your billing system and administrative processes may be needed, along with learning new billing codes and complying with updated guidelines.
More collaboration with community-based organizations may be needed, including coordinating care plans and sharing information to help support for children and their families.
You should plan to review the member’s eligibility and benefits to verify which services require prior authorization or notification
Have questions?
For more information about HCBS services in New York and resources to help prepare your practice, review the Children’s Home and Community Based Services (HCBS) Manual.
For additional questions, please reach out to your Network Manager.
