What Are Home and Community-Based Services?

What Are Home and Community Based Services?

The Children's Home and Community-Based Services is a program designed to help children with disabilities receive necessary healthcare services in their homes and communities.

The program aims to provide families with the resources they need to care for their children while also promoting independence, inclusion, and community participation.

Through this waiver, children can access a range of services that are tailored to meet their unique needs, including medical equipment, therapy, nursing care, and more.

By enabling families to care for their children at home rather than in institutional settings, the waiver not only improves health outcomes but also enhances quality of life for both the child and their family.

What is the Home and Community-Based Services 1915(c) Children's Waiver?

Home and Community Based Services (HCBS) are a type of Medicaid service that is designed to provide children and youth with access to developmentally and culturally appropriate services in their home and community. These services aim to help individuals participate in their daily activities while receiving the necessary support and care.

New York State (NYS) is committed to serving individuals in the least restrictive environment possible. This means that NYS aims to provide services and supports to children/youth and their families at home and in the community, rather than in more restrictive institutional settings.

By providing HCBS, NYS can help individuals receive the necessary services and supports they need to remain in their homes and communities.

HCBS can include a range of services, such as community habilitation, respite care, pre-vocational services, palliative care and more. These services are designed to be flexible and tailored to the individual needs of each child/youth, with the goal of promoting maximum independence and quality of life.

HCBS are an essential tool for promoting the independence and well-being of children and youth with disabilities or complex medical needs. By providing the necessary services and supports in the least restrictive environment possible, HCBS can help improve outcomes for individuals by ensuring that they have access to the resources they need to thrive

Understanding the Vision and Goals of Children's HCBS

At its core, Children's HCBS is about supporting children and youth in the most nurturing environment possible: their home and community. These services are designed to provide families with the support they need to help their children succeed at home, in school, and in other natural environments.

Children's HCBS is family-driven and youth-guided, meaning that the focus is on meeting the unique needs and preferences of each individual child/youth. Services are tailored to meet the physical health, developmental, and behavioral health needs of each child/youth, with a culturally and linguistically appropriate approach.

One of the core goals of Children's HCBS is to provide a flexible, complimentary package of services that evolves over time to meet the changing needs of the child/youth. This allows families to have independent choice among an array of service options and providers.

Notably, Children's HCBS is intended to be provided in the least restrictive environment possible. These services are designed to help children/youth maintain success in their natural environments and avoid higher levels of care or out-of-home placements.

Overall, Children's HCBS is a compassionate and empathetic approach to supporting children and youth with disabilities or complex medical needs. By providing tailored services and supports in the home and community settings, Children's HCBS can help improve outcomes for individuals by ensuring that they have access to the resources they need to thrive.

Eligibility Requirements for HCBS Children's Waiver

The Children's Waiver is a program that aims to provide compassionate care to children with disabilities while allowing them to remain in their homes and communities. To be eligible for this Medicaid program, certain criteria must be met. These include:

To be eligible for the HCBS Children's Waiver, children and youth must meet the following requirements:

1. The child/youth must be under the age of 21.
2. The child/youth must meet a Level of Care (LOC) determination, which requires completion of the HCBS/LOC Eligibility Determination tool within the Uniform Assessment System (UAS).
3. The child/youth must fall into one of the following LOC groups:

• Serious Emotional Disturbance (SED)
• Medically Fragile Children (MFC)
• Developmental Disability (DD) and Medically Fragile
• Developmental Disability (DD) and Foster Care

Please note that LOC determinations are based on the child/youth's individual needs and circumstances.

It's important to note that eligibility requirements may vary by state, so it's essential to check with your local Medicaid agency to confirm the specific criteria in your area. By meeting these eligibility requirements, families can determine if the Children's Waiver is a viable option for their child's care needs.

What services and supports does the Children's Home and Community-Based Services Provide?

The Children's HCBS provides a variety of services and supports to eligible children and their families. These include:

• Community Habilitation
• Day Habilitation
• Caregiver/Family Advocacy and Support Services
• Prevocational Services
• Supported Employment
• Respite Services (Planned Respite and Crisis Respite)
• Palliative Care
• Environmental Modifications
• Vehicle Modifications
• Adaptive and Assistive Technology
• Non-Medical Transportation

HCBS is a comprehensive system of care that takes into account the unique strengths, preferences, and needs of each individual child. By offering an array of services, HCBS aims to help children remain in their communities and avoid higher levels of care and out-of-home placements.

Through this approach, children can receive the support they need to live fulfilling lives while remaining close to their families and friends. By promoting independence, self-determination, and community integration, HCBS helps children with disabilities achieve their full potential.

Children's HCBS: Services Provided Explained

The services and supports provided through the Children's HCBS Waiver are tailored to meet the individual needs of each child.

1. Community Habilitation

Community habilitation services are designed to provide individuals with the support they need to learn social and daily living skills, as well as health-related tasks, in their local community. These services aim to help individuals develop the skills necessary to live independently by providing them with the necessary education and support.

Community habilitation services can include a range of activities, such as classes on how to cook healthy meals and practice good nutrition, training on how to perform daily living tasks like cleaning and personal hygiene, and instruction on how to manage health-related tasks like medication administration or managing chronic conditions.

For many individuals with disabilities or complex medical needs, learning these skills can be challenging. Community habilitation services aim to address these challenges by providing tailored instruction and support that helps individuals develop the skills they need to succeed in their daily lives.

2. Day Habilitation

Day habilitation services are designed to provide individuals with the support they need to learn social and daily living skills in an agency setting. These services aim to help individuals build relationships, take part in community activities, and gain independence while making informed choices.

Day habilitation services can include a range of activities, such as classes on how to communicate effectively with others, training on how to perform daily living tasks like cooking and cleaning, and opportunities to participate in community events and activities.

For many individuals with disabilities or complex medical needs, learning social and daily living skills can be challenging. Day habilitation services aim to address these challenges by providing tailored instruction and support that helps individuals develop the skills they need to succeed in their daily lives.

3. Caregiver/Family Advocacy and Support Services

Caregiver/family advocacy and support services are designed to provide training and education to caregivers/families of children with developmental, medical, and/or mental health needs. These services aim to help caregivers and families make informed and empowered choices for their children by providing them with the necessary knowledge and resources.

Advocacy and support services can include a range of activities, such as training on how to advocate for a child's needs within the healthcare system, education on how to navigate the complex network of available resources and services, and support in developing a plan for maintaining and strengthening a child or youth's independence in the community.

For many caregivers and families of children with disabilities or complex medical needs, navigating the complex healthcare system can be overwhelming. Caregiver and family advocacy and support services aim to address these challenges by providing customized education and support that helps caregivers and families develop the skills they need to advocate for their child's needs effectively.

4. Prevocational Services

Prevocational services are designed to help youth aged 14 and older learn the skills they need to prepare for paid work or volunteer work that matches their interests. These services provide instruction and support to help individuals develop the skills necessary to succeed in the workplace.

Prevocational services can include a range of skill-building activities, such as communication training to help individuals effectively interact with supervisors, coworkers, and customers, workplace problem-solving exercises to help them address common challenges encountered in the workplace, career planning guidance to help them identify potential career paths and develop a plan for achieving their goals, and workplace safety training to ensure they understand how to stay safe on the job.

For many youth with disabilities or complex medical needs, navigating the transition from school to work can be challenging. Prevocational services aim to address these challenges by providing tailored instruction and support that helps individuals develop the skills they need to succeed in the workplace.

5. Supported Employment

Supported employment is a service that helps youth aged 14 and older who are ready for a job to find and maintain steady employment that pays wages. This service provides ongoing support to individuals while they are seeking employment and while they are working.

Supported employment services can include a range of supports, such as assistance with finding a job that matches an individual's skills and interests, job coaching to help them learn the skills needed to succeed in their job, benefits support to ensure they have access to necessary healthcare and other benefits, and workplace support services to help them advance their career and succeed in their chosen field.

For many youth with disabilities or complex medical needs, finding and maintaining employment can be challenging. Supported employment services aim to address these challenges by providing tailored supports that help individuals overcome barriers to employment and achieve their career goals.

6. Respite Services

Respite services provide short-term relief for families and caregivers who are responsible for the care of children and youth with disabilities or complex medical needs. These services may be delivered in the home, in the community, or in another allowable location, depending on the needs of the child and their family.

Planned respite services are designed to give families and caregivers a break from the demands of caregiving while supporting the child's mental health and/or healthcare goals. These services may include activities such as recreational outings, social events, or educational activities, and may be provided on a regular basis to ensure that families and caregivers have an opportunity to recharge and take care of their own needs.

Crisis respite services provide short-term relief from a mental health, substance use, and/or healthcare crisis event that could lead to a higher level of care if not addressed promptly. These services are often designed to provide immediate support to children and youth when they need it most, with the goal of stabilizing their condition and preventing further deterioration.

7. Palliative Care

Palliative care is a specialized type of care provided to children and youth with chronic or life-threatening illnesses. This type of care focuses on improving the quality of life for these individuals, by managing symptoms, providing emotional support, and addressing their unique needs.

Palliative care can take many forms, including massage therapy to help relieve physical symptoms, art, music, and play therapy to help children better understand and express their emotions, and pain management services to help relieve or control suffering.

In addition to physical and emotional support, palliative care also provides counseling and support services to help children and youth with chronic or life-threatening illnesses and their families cope with the challenges they may face. These services may include grief counseling and support to help families navigate difficult decisions related to end-of-life care.

8. Environmental Modifications

Environmental modifications refer to changes made to a child or youth's home environment to support their health needs. These modifications may involve alterations to the physical structure of the home, such as widening doorways to accommodate mobility aids or installing grab bars in the bathroom to prevent falls.

For children and youth with disabilities, environmental modifications can be essential tools for promoting independence and improving quality of life. By making changes to the home environment, individuals with disabilities may be better able to perform daily activities, access necessary medical care, and participate in social activities.

Examples of common environmental modifications include the installation of ramps or lifts to improve accessibility, the addition of specialized lighting or soundproofing to address sensory needs, or the installation of air filtration systems to improve air quality for individuals with respiratory conditions.

9. Vehicle Modifications

Vehicle modifications are changes made to a child or youth's vehicle to support their health needs. These modifications may include alterations to the vehicle's structure, such as adding wheelchair lifts or ramps, or installing specialized equipment to accommodate medical devices or mobility aids.

For children and youth with disabilities, vehicle modifications can be essential tools for promoting independence and community participation. By making it easier for these individuals to access transportation, vehicle modifications can help them attend medical appointments, therapy sessions, school, and social activities.

Examples of common vehicle modifications include the installation of hand controls for individuals who have limited mobility in their legs, or the addition of specialized seats or harnesses for individuals who require extra support while riding in a vehicle.

10 Adaptive and Assistive Technology

For children and youth with disabilities, technological aids and other devices can play a crucial role in supporting their health, welfare, and safety. These aids may take various forms, including assistive technologies such as hearing aids, communication devices, or mobility aids.

Assistive technologies can help children and youth with disabilities overcome barriers to participation and achieve greater independence. For example, a child who has difficulty communicating verbally may benefit from a communication device that allows them to express themselves more effectively. Similarly, a child with mobility challenges may benefit from an assistive device that improves their mobility and accessibility.

11. Non-Medical Transportation

One of the key benefits of certain programs aimed at supporting individuals who have disabilities is transportation assistance. This assistance can take many forms, including transportation to and from medical appointments, therapy sessions, or community activities that align with the individual's goals.

By providing transportation support, these programs seek to help individuals access the services and activities they need to achieve their goals, while also promoting independence and community integration. Transportation assistance can be especially valuable for individuals who face mobility challenges or who live in areas with limited public transportation options.

These services all play a crucial role in helping children with disabilities stay safe and live meaningful lives.

Who Provides the Services?

The Home and Community-Based Services 1915(c) Children's Waiver is administered by each state's Medicaid agency. The agency contracts with various provider agencies to deliver services to eligible children and their families. These providers may include:

• A child serving agency or agency with children’s behavioral health and health experience and 
• Be an OMH, OASAS, OCFS, DOH, or OPWDD provider, that is licensed, certified, designated, and/or approved by OMH, OASAS, OCFS, OPWDD, or DOH or its designee to provide comparable and appropriate services referenced in the service definition. 

Provider agencies must also be Medicaid enrolled.

It's important for families to choose a provider that they feel comfortable with and who can meet their child's unique needs. Families may want to consider factors such as experience working with children with disabilities, availability of services in their area, and compatibility with their child's care plan.

Duration of Home and Community-Based Services Under the 1915(c) Children's Waiver

The length of time a child or youth can receive home and community-based services through the 1915(c) Children's Waiver varies depending on several factors. In general, services are provided as long as the individual meets eligibility criteria and their needs continue to require support.

However, there may be limitations on the amount of services that can be provided each year, based on available funding and the needs of other individuals receiving services. Some states may also have waiting lists for certain services due to high demand.

It's important for families to work closely with their service providers and care managers to understand the duration of services they can receive and plan for any transitions that may occur as their child grows older or their needs change.

How does the Children's Waiver work with other Medicaid services?

The Children's Waiver is a Medicaid program that provides home and community-based services to eligible children with disabilities. It works in conjunction with other Medicaid services to ensure that children receive comprehensive, coordinated care.

For example, if a child is enrolled in both the Children's Waiver and Medicaid Managed Care, their case manager will work with both programs to develop a care plan that meets all of their needs. The child may receive additional services through Medicaid Managed Care, such as dental or vision care.

Additionally, if a child requires hospitalization or specialized medical care outside of the scope of the waiver program, they may still be covered by traditional Medicaid benefits. This ensures that children receive the appropriate level of care at all times.

The coordination between different Medicaid programs can be complex, but it ultimately benefits families by providing comprehensive coverage for their child's health needs. Families should work closely with their care manager to understand how different programs work together and ensure that their child receives all necessary services and supports.

How can someone access Children’s HCBS?

The process for accessing the Home and Community-Based Services 1915(c) Children's Waiver can vary by state, but the first step is to reach out to a provider agency that offers HCBS services or contact your local Medicaid office. They will be able to provide more information about the program and help you determine if it is an appropriate option for your child's care needs.

If so, they will guide you through the application process and provide any necessary resources and assistance. It is important to remember that this process can take time, so it is best to start as soon as possible. Additionally, it may be helpful to enlist the support of a professional, such as an advocate or social worker, who can guide you through the process and ensure that everything runs smoothly.

How do I apply for the Children's Waiver?

To apply for the Children's Waiver, you will need to contact a designated HCBS provider agency (such as Yeled V’Yalda) or your state's Medicaid office. They will provide you with an application and guide you through the process. You will need to provide information about your child's disability and medical needs, as well as insurance information to determine eligibility.

Applying for the Children's Waiver can be a lengthy and complex process, but it is worth it to receive the necessary services and supports for your child. Remember that you are not alone in this process and there are resources available to help you.

Conclusion

In conclusion, the Children's Waiver is a valuable option for families of children with disabilities who may require a nursing facility level of care. By providing services and supports in the home and community, children can receive necessary care while still being able to participate in their families and communities. If you think your child may be eligible for the Children's Waiver, contact a designated HCBS provider agency or your state's Medicaid office to learn more.