Children and Youth Evaluation Services (C-YES): What You Need to Know

As a parent or guardian of a child with developmental disabilities, it can be challenging to navigate the complex healthcare system and find the right services to support your child's needs. That's where Children and Youth Evaluation Services (C-YES) come in. C-YES is a program offered by Children's HCBS NY that provides evaluations and assessments to children and youth with developmental disabilities to determine their eligibility for services.

What is Children and Youth Evaluation Services (C-YES)?

The Children and Youth Evaluation Service (C-YES) is an independent entity that is designated by the state. Its primary role is to determine eligibility for Home and Community-Based Services (HCBS) and Level of Care (LOC) for children who are eligible for HCBS but are not yet enrolled in Medicaid.

C-YES also assists children with filling out Medicaid applications. Once a child is deemed eligible for HCBS, C-YES develops a plan of care (POC) for the services they require, and refers them to the appropriate HCBS providers. C-YES also monitors access to care for children who opt out of HH (Health Home) care management.

In summary, C-YES is responsible for the following:

• Conducting HCBS/LOC eligibility determinations
• Providing Medicaid application assistance for eligible children
• Developing an HCBS POC for eligible children
• Referring eligible children to HCBS providers
• Monitoring access to care for children who opt out of HH care management

How Does C-YES Help?

C-YES (Children and Youth Evaluation Services) is an organization that evaluates whether children and youth are eligible for Home and Community-Based Services (HCBS) covered by New York State Medicaid. If a child or youth is not enrolled in Medicaid, they should be referred to C-YES for evaluation.

During the evaluation process, Registered Nurses meet with children and youth to assess whether they qualify for HCBS. If they are found eligible, C-YES will assist them in applying for Medicaid. However, it's important to note that C-YES does not determine eligibility for Medicaid itself.

Why are C-YES evaluations important?

The Children and Youth Evaluation Service (C-YES) provides a comprehensive evaluation of a child's medical and developmental history, as well as their current functioning level. This information is important for several reasons, including:

1. Determining eligibility for services

C-YES evaluations are used to determine a child's eligibility for Home and Community-Based Services (HCBS) and Level of Care (LOC). This is important because it ensures that children receive the appropriate level of care based on their individual needs.

2. Identifying the most appropriate services

The evaluation process takes into account a child's unique needs, which allows healthcare providers to develop a personalized treatment plan that addresses those needs. This can include a range of services such as therapy, medical equipment, and home modifications.

3. Facilitating communication between healthcare providers and families

C-YES evaluations provide families with a better understanding of their child's needs and help to facilitate communication between healthcare providers and families. This can lead to better outcomes for the child and a more coordinated approach to their care.

4. Improving overall health outcomes

By identifying a child's specific needs and providing appropriate services, C-YES evaluations can improve overall health outcomes for children. This can include improved physical health, mental health, and quality of life.

C-YES evaluations are important because they help to determine eligibility for services, identify the most appropriate services, facilitate communication between healthcare providers and families, and improve overall health outcomes.

What services are available through C-YES?

Children and Youth Evaluation Services (C-YES) provide access to a range of services that are designed to support children and youth with developmental disabilities. These services include:

Home and community-based services (HCBS)

These services are designed to support children and youth with developmental disabilities to live in their homes and communities. HCBS services may include personal care, respite care, and environmental modifications.

Behavioral health services

These services are designed to support children and youth with mental health and behavioral health needs. Behavioral health services may include counseling, therapy, and medication management.

Speech and language therapy

Speech and language therapy is designed to support children and youth with communication disorders. This may include speech therapy, language therapy, and assistive technology.

Occupational therapy

Occupational therapy is designed to support children and youth with physical, cognitive, and sensory disabilities. This may include activities to improve fine motor skills, sensory integration, and daily living skills.

Physical therapy

Physical therapy is designed to support children and youth with physical disabilities. This may include activities to improve mobility, strength, and endurance.

Overall, Children and Youth Evaluation Services (C-YES) provides families with access to a range of services that are designed to support children and youth with developmental disabilities. The program is designed to be comprehensive and takes into account the child's unique needs, strengths, and challenges.

Requirements for Children and Youth Referred to the Children's Waiver without Active Medicaid

Children and youth who are referred to the Children's Waiver for Home and Community-Based Services (HCBS), but do not have active Medicaid, need to go through a process to determine their eligibility.

1. Referral to Children and Youth Evaluation Services (C-YES) for an HCBS Level of Care (LOC) Eligibility Determination.
2. If eligible, C-YES assists the family with completing and submitting a Medicaid application to the Local District of Social Services (LDSS).
3. LDSS determines Medicaid eligibility by following the standard Medicaid budgeting process, first determining whether the family is eligible for Medicaid under "Community Eligible". If not, then LDSS should determine if the child/youth is eligible as a "Family of One" Medicaid based on their eligibility for the Children's Waiver.
4. Once LDSS has determined Medicaid eligibility, they designate Children's Waiver enrollment status by adding Recipient Restriction Exception (RR/E) codes (i.e., "K-codes") on the child/youth's Medicaid file in the Welfare Management System (WMS).
5. All Children's Waiver enrollees will have a K1-code. Children/youth will also have a K-code to indicate their target population.
6. Children/youth determined Medicaid eligible as a "Family of One" will also have a KK-code to indicate this status.
7. It's important to verify Medicaid eligibility before requesting a KK-code be added to a child's/youth's Medicaid file.

In summary, children and youth who are referred to the Children's Waiver for HCBS and do not have active Medicaid need to go through a process to determine their eligibility. C-YES determines eligibility for the waiver, and LDSS determines Medicaid eligibility. Once a child is deemed eligible for Medicaid, LDSS will add K-codes to the child's/youth's Medicaid file to designate Children's Waiver enrollment status.

Requirements for Children/Youth Referred for Health Home Care Management through C-YES Transfer

1. C-YES serves children/youth who are either:

• enrolled in Medicaid and opt-out of Health Home comprehensive care management, or
• not already enrolled in Medicaid but identified by a referral source as potentially needing Home and Community-Based Services (HCBS).

1. In either case, C-YES educates the child/youth/family about HH care management, C-YES care coordination, and HCBS eligibility and services.
2. If a child/youth is already enrolled in Medicaid, they may choose whether to proceed with the HCBS/LOC eligibility process with C-YES or be connected to a Health Home (HH) to be enrolled so that the HH care manager can conduct the HCBS/LOC eligibility determination.
3. If a Medicaid-enrolled child/youth/family is referred to C-YES but decides they want to transfer to an HH Care Management Agency (HH/CMA) before the HCBS/LOC is completed or other information is obtained, then C-YES only needs to complete the "Transfer Referral Form for C-YES, Health Homes, and Care Management Agencies" and not the "Opt-in to Health Home form".
4. When documentation is needed for a transfer to HH, all required transfer documentation needs to be securely sent immediately and noted on the "Transfer Referral for C-YES, Health Homes, and Care Management Agencies" form.
5. Verification of appropriate K-codes on the transferring child/youth Medicaid file is necessary.
6. C-YES is required to monitor the K-code additions by the LDSS and share this information with the receiving HH/CMA if there is a delay in K-codes; however, the transfer case cannot be refused for this reason.
7. The transfer date and the HH/CMA assuming case responsibility cannot occur until the K-codes are on the child's/youth's Medicaid file. However, the processes of the transfer should continue and not be delayed.

How to Prepare for a C-YES Evaluation Appointment

Preparing for a C-YES evaluation can help ensure that the process goes smoothly and that your child receives the appropriate level of care. Here are some tips to help you prepare for a C-YES evaluation appointment:

1. Gather all necessary documents

Before your appointment, make sure to gather all necessary documents, including medical records, school reports, and any other relevant information about your child's developmental history. This will help ensure that the evaluator has all of the information they need to make an accurate assessment.

2. Talk to your child about the appointment

It's important to talk to your child about the upcoming appointment and let them know what to expect. Let them know that they will be meeting with someone who wants to learn more about them and their needs.

3. Make a list of questions

Make a list of questions you have about the evaluation process or any services that may be recommended for your child. This will help ensure that you get all of the information you need during the appointment.

4. Bring someone with you

Consider bringing another adult with you to the appointment who can provide support and take notes during the evaluation.

5. Be prepared to discuss your child's strengths and challenges

During the evaluation, be prepared to discuss your child's strengths and challenges in detail. This will help ensure that the evaluator has a complete understanding of your child's needs.

By following these tips, you can help ensure that your child's C-YES evaluation goes smoothly and that they receive the appropriate level of care based on their unique needs.

The Role of Parents/Guardians in the C-YES Evaluation Process

Parents and guardians play a critical role in the Children and Youth Evaluation Service (C-YES) evaluation process. They are the primary source of information about their child's medical and developmental history, as well as their current functioning level. Here are some ways that parents and guardians can be involved in the C-YES evaluation process:

1. Providing detailed information about their child

During the evaluation, parents and guardians will be asked to provide detailed information about their child's medical and developmental history. This may include information about any diagnoses or conditions, medications, therapies, or previous treatments.

2. Participating in assessments

Parents and guardians may also be asked to participate in assessments with their child. This may include observing their child's behavior or participating in interviews with healthcare providers.

3. Asking questions

It's important for parents and guardians to ask questions during the evaluation process if they don't understand something or need more information. This can help ensure that they have a clear understanding of their child's needs and what services may be recommended.

4. Being an advocate for their child

Finally, parents and guardians can serve as advocates for their child throughout the C-YES evaluation process. This may include advocating for specific services or treatments that they believe would benefit their child, or ensuring that their child is receiving appropriate care based on their individual needs.

By playing an active role in the C-YES evaluation process, parents and guardians can help ensure that their child receives the appropriate level of care based on their unique needs.

Summary

Children and Youth Evaluation Services (C-YES) is a program that provides access to comprehensive services for children and youth with developmental disabilities. The program is designed to identify the specific needs of each child, facilitate communication between healthcare providers and families, and improve overall health outcomes.

C-YES offers a range of services including home and community-based services (HCBS), behavioral health services, speech and language therapy, occupational therapy, and physical therapy. Children who are referred to the Children's Waiver for HCBS but do not have active Medicaid need to go through a process to determine their eligibility.

Parents/guardians play a critical role in the C-YES evaluation process by providing detailed information about their child's medical and developmental history, participating in assessments, asking questions, and being an advocate for their child.

To prepare for a C-YES evaluation appointment, parents should gather all necessary documents, talk to their child about the appointment, make a list of questions they have about the evaluation process or any recommended services, bring someone with them for support during the evaluation, and be prepared to discuss their child's strengths and challenges.

Sources

• New York State Department of Health. (2021). Children & Youth Evaluation Services (C-YES).
• New York State Department of Health. (2021). Requirements for Children/Youth Referred for Health Home Care Management through C-YES Transfer.
• New York State Department of Health. (2021). Requirements for Children and Youth Referred to the Children's Waiver without Active Medicaid.
• Children's HCBS NY. (n.d.). Children and Youth Evaluation Services (C-YES).
• New York State Department of Health. (n.d.). Children and Youth Evaluation Services (C-YES).