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WNYLC Online Resources / Home / Medicaid / Other Services / Medicaid 1915(c) Home-and-Community-Based Services (HCBS) Waiver...

Medicaid 1915(c) Home-and-Community-Based Services (HCBS) Waiver Programs in New York State

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Views: 121088
Posted: 02 Sep, 2010
by Valerie Bogart (New York Legal Assistance Group)
Updated: 02 Feb, 2026
by Rachel Holtzman (New York Legal Assistance Group)

Jan. 26, 2026 ALERT: The NHTD HCBS Waiver enrollment cap has been reached, so the waiver is now full. The DOH NHTD waiver website states "Because we have reached the approved maximum number of participants, we cannot process any additional referrals to the Nursing Home Transition and Diversion waiver at this time. Any referrals received will be closed via letter and will not move forward to intake."

January 23, 2026 ALERT: DOH released a new Medicaid Alert regarding Renewal/Recertification for OPWDD HCBS Waiver for Minors. (This is an updated version of the same Medicaid Alert originally released December 30, 2025.) It clarifies that "[a]part from some limited exceptions, clients who are not eligible for Medicaid through Supplemental Security Income (SSI) must complete an annual Medicaid renewal/recertification . . . . Clients who get HCBS Waiver services must still meet Medicaid eligibility criteria to receive coverage with waiver easements and remain enrolled in the HCBS Waiver." It also clarifies the type of budgeting that must be considered.

Dec. 2025 ALERT: CMS has approved NYS DOH's proposal to cap the number of people who may enroll in the Nursing Home Transition & Diversion Waiver (NHTD). The amended NHTD waiver can be found here.

Note: For a quick introduction to the four 1915(c) HCBS waivers in New York State, see this  powerpoint titled "NYLAG Presentation about 1915(c) HCBS waivers." Please feel free to share those slides, as well as the material below, widely.

In this article:

Part 1 – Introduction to 1915(c) Home & Community Based Services (HCBS) Waivers

  • Types of HCBS Services: “State Plan” HCBS services (including Personal Care and CDPAP) compared to 1915(c) HCBS waiver services
  • How to Access “State Plan” HCBS services

Part 2 – Overview of the four 1915(c) HCBS Waivers in New York State

  1. Traumatic Brain Injury (TBI) Waiver
  2. Nursing Home Transition & Diversion (NHTD) Waiver
  3. Office for People with Developmental Disabilities (OPWDD) Waiver
  4. Children’s Waiver

Part 3 – 1915(c) HCBS Waivers and EPSDT – the federal Medicaid protection for children

Part 4 – Where to Find Free Legal Help

Part 5 – Additional Resources about 1915(c) HCBS Waivers – and Legal Citations

Part 1 – Introduction to 1915(c) Home & Community Based Services (HCBS) Waivers 

New York offers a variety of home-based and community-based services to people enrolled into Medicaid in the state. Some of those home-based and community-based services are offered through Medicaid Home- and Community-Based Services waivers (“HCBS waivers”). HCBS waivers are designed for certain groups of individuals who would be eligible for Medicaid if institutionalized and, but for the HCBS services, would be institutionalized in a hospital or nursing facility. The authority for these waiver programs comes from section 1915(c) of the Social Security Act, thus these waivers are sometimes referred to as “1915(c)” HCBS waivers. Through 1915(c) HCBS waivers, the federal government gives states permission to waive certain requirements that are otherwise applicable (more on this below).

Congress enacted section 1915(c) of the Social Security Act in the Omnibus Reconciliation Act (OBRA) of 1981. Until then, comprehensive long-term care services through Medicaid were mostly available in institutional settings. Although mandatory home health services and optional personal care services were available as Medicaid “State Plan services” before OBRA 1981, states had largely restricted their use and limited the amount of services. New York was an exception with its expansive personal care program and the Lombardi or Long Term Home Health Care Program (LTHHCP), which was a program established by Chapter 895 of the New York Laws of 1977 (but no longer exists). In fact, Congress reportedly modeled 1915(c) HCBS waivers in part on New York’s experience with the Lombardi program.

In 1915(c) HCBS waivers, CMS waives key requirements that apply to “State Plan” services, described further below.

1915(c) HCBS waivers have grown nationally with the momentum to “rebalance” long term care services from institutional care to home-based and community-based care. However, 1915(c) HCBS waivers are not the only model for delivering Medicaid home care services. To understand the landscape for delivery of Medicaid long term care services, one must first look at different types of services and then at the different models for delivering those services.

Types of Home & Community-Based Services: State Plan HCBS services vs. 1915(c) HCBS Waiver services

  1.  State Plan HCBS Services

Every state has a “State Medicaid Plan,” which describes in detail which services are covered by the state’s Medicaid program, along with who is eligible. Some services are “mandatory” in every state, and other services are “optional” for the State. New York has long led the nation in providing expansive State Plan homecare services. These include personal care services (PCS) with its self-directed option, Consumer Directed Personal Assistance Program (CDPAP), which are both “optional” State plan services, meaning that a State may elect to include them in the state plan. New York also provides expansive certified home health agency (CHHA) services, which is a “mandatory” service that all States must include for adults in the state plan. (Note that all section 1905(a) services, be they “mandatory” or “optional,” must be covered for Medicaid-enrolled children under 21 years old, per the EPSDT requirement.) For the mandatory and optional benefits covered as “State Plan” services, the state has discretion to define the amount, duration and scope of the services, provided the state complies with the following federal requirements:  

  • Statewideness (Section 1902(a)(1)): State plan services must be provided statewide.
  • Income and resource rules applicable in the community (Section 1902(a)(10)(C)(i)(III)): Within federal guidelines, States set limits on income and resources. States have the option of allowing people with excess income to “spend down” the excess income on medical bills to qualify for Medicaid. NYS opts to have a “spend-down” program, also known as the “medically needy” category. This is in addition to the “categorically needy” category that is mandatory for all states, which covers those in certain categories (age 65+, disabled, children and their caretaker relatives) whose incomes are below the State-defined Medicaid limits.
  • Comparability of services (Section 1902(a)(10)(B)): Services must be equally available to any category, such as young vs. aged vs. disabled, or those whose who are “medically needy” and “categorically needy.”  
  • No Waiting Lists or Caps on Number of People who may use the services. If an individual meets the eligibility criteria for a State plan service, the service must be provided to them. They may not be put on a waiting list, though delays may still be encountered.

State Plan HCBS services that must meet the above requirements include:

  1. Mandatory Services:
    1. Certified Home Health agency services (visiting nurse, home health aide, in-home physical, speech and occupational therapy, durable medical equipment, and medical supplies) for anyone who would be entitled to nursing home services.
    2. Nursing home services (this is not an HCBS service, but listed here to show that states MUST provide nursing home care, but most HCBS services are optional).
    3. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services - For children under age 21, all Social Security Act section 1905(a) services are mandatory even if they are otherwise “optional” for adults. See more on our New York Health Access article, Early and Periodic Screening, Diagnostic and Treatment (EPSDT).

  1. Optional Services (New York State covers all of the services listed below, within defined limits)
    1. Personal care services
    2. Consumer Directed Personal Assistance Program (CDPAP)
    3. Assisted Living Program (ALP)
    4. Private Duty Nursing
    5. Community First Choice Option (CFCO) New York opted to provide the state plan CFCO program, but NYS offers no actual separate CFCO service that one may apply for. Instead, NYS designated both state-plan Personal care and CDPAP as CFCO services. NYS designates which personal care and CFCO recipients have a “Nursing Home Level of Care” (NFLOC) score of 5, which is derived from the Uniform Assessment conducted by a nurse to determine eligibility for these services. For those who have an NFLOC score of 5, NYS receives six percent extra federal reimbursement for the cost of the services. As a state plan service, CFCO must be provided statewide to anyone eligibl See NYS DOH 19ADM-01 - Community First Choice Option.
    6. Adult Day Health Care
    7. PACE program (Program for the All-Inclusive Care for the Elderly) (age 55+)
    8. Hospice care

To view New York’s Medicaid State Plan, and all subsequent Proposed and Approved State Plan Amendments since 2011, see the links below:

How New Yorkers Access State Plan HCBS Services, including Personal Care and CDPAP

All Medicaid recipients – including those enrolled in a 1915(c) HCBS waiver – have the right to apply for any State Plan HCBS service. How Medicaid recipients access State plan HCBS services depends on various factors – including whether they have Medicare in addition to Medicaid, their age, whether they are enrolled in a hospice program, and whether they are enrolled in one of the 1915(c) HCBS waivers discussed below. Here is how different groups of people access State Plan HCBS services such as personal care and CDPAP.

  1. Adult Dual Eligibles – Most* New Yorkers age 21 and over who have Medicare and Medicaid (“dual eligibles”) are required to enroll in and access most of the State Plan services listed above, including personal care and CDPAP, from a Managed Long Term Care (MLTC) plan, or at their option from a Medicaid Advantage Plus (MAP) or PACE plan. The exception is the Assisted Living Program, for which they apply directly, without enrolling in an MLTC plan.

*There are limited exceptions from mandatory enrollment in MLTC plans:

    1. People enrolled in a home hospice program
    2. People enrolled in the three 1915(c) HCBS waivers available for New Yorkers age 21 and over: OPWDD waiver, Traumatic Brain Injury (TBI) waiver, and Nursing Home Transition & Diversion (NHTD) waiver. (See Part 2 for more on these waivers, as well as the fourth 1915(c) HCBS waiver which is exclusive to children under age 21.)

  1. People with Medicaid only (who do not have Medicare or other comprehensive insurance). Most* adults and children who have Medicaid only are required by state law to enroll in a “mainstream” Medicaid managed care plan to obtain any Medicaid service, including the above State Plan HCBS services. The exceptions are for the Assisted Living Program and the PACE program (a type of managed long term care plan only for individuals age 55 and over), which are both accessed separately, with no enrollment in a Medicaid managed care plan.

*There are limited exceptions from the mandatory enrollment into mainstream Medicaid managed care plans. For a full list of everyone exempt or excluded from the requirement to enroll into mainstream Medicaid managed care, see the New York State Department of Health chart, Medicaid Managed Care: Exclusions and Exemptions. People who are “exempt” have the option of enrolling in a mainstream managed care plan but are not required to enroll, whereas people who are “excluded” may not enroll in a mainstream managed care plan. A few examples of people exempt or excluded from enrolling into a mainstream Medicaid managed care plan include:

  • Any person in receipt of comprehensive private health insurance is excluded from mainstream Medicaid managed care. This includes adults, as well as children who might be covered under a parent’s health insurance plan.
  • Any person enrolled in the OPWDD waiver, TBI waiver, or NHTD waiver is exempt from mainstream Medicaid managed care.
  • Any person who is eligible for OPWDD services – in the waiver or otherwise – and thus has a code 95 is exempt from mainstream Medicaid managed care.
  • Any person receiving family planning services only, meaning they are not fully eligible for Medicaid but are eligible for the Family Planning Benefit Program (“FPBP”) are excluded from mainstream Medicaid managed care.

For any Dual Eligible or person with Medicaid only who is exempt or excluded from enrolling in an MLTC or mainstream Medicaid managed care plan, they access State Plan personal care and CDPAP services from their local Department of Social Services (LDSS, or in NYC, HRA). They access Private Duty Nursing services directly from the New York State Department of Health (their provider must first request “prior authorization” and receive approval for the services).

  1. 1915(c) HCBS Waiver Services

As described by CMS on its Home & Community-Based Services 1915(c) page:

“States can waive certain Medicaid program requirements under HCBS Waivers, including:

  • Statewideness (Section 1902(a)(1)): Lets States target waivers to areas of the state where the need is greatest, or where certain types of providers are available.
  • Comparability of services (Section 1902(a)(10)(B)): Lets States make waiver services available only to certain groups of people who are at risk of institutionalization. For example, States can use this authority to target services to the elderly, technology-dependent children, people with behavioral conditions, or people with intellectual disabilities. States might also target services on the basis of disease or condition, such as Acquired Immune Deficiency Syndrome.
  • Income and resource rules applicable in the community (Section 1902(a)(10)(C)(i)(III)): “Lets States provide Medicaid to people who would otherwise be eligible only in an institutional setting, such as those who would be ineligible in the community due to the income and resources of a spouse or parent. States can also use spousal impoverishment rules to determine financial eligibility for waiver services.”

Part 2 of this article below describes each of the four 1915(c) HCBS waivers in NYS, listing their eligibility criteria and how to access them. Also listed for each of the four waivers are the HCBS waiver services in each waiver. As a reminder, HCBS waiver services are not in the State Plan and are uniquely available to enrollees of the HCBS waivers.

People enrolled in 1915(c) HCBS Waivers may still access State Plan home-and community based services – including State Plan personal care, CDPAP and other services listed above – like any other Medicaid recipient. But how each 1915(c) HCBS waiver enrollee accesses State Plan services, varies depending on whether the Medicaid recipient is enrolled into a Medicaid managed care plan. Note that in New York, most Medicaid recipients are required to enroll in either a Managed Long Term Care (MLTC) plan or a “mainstream” Medicaid managed care plan. To learn more about Medicaid Managed Care, see our article titled Medicaid Managed Care.

  • For 1915(c) HCBS waiver enrollees who are enrolled in a Medicaid managed care plan: These managed care plan must provide State Plan services to any member who is eligible for them.
  • For 1915(c) HCBS waiver enrollees who are not enrolled in a Medicaid managed care plan: The Medicaid recipient’s Local Department of Social Services (LDSS, or HRA in New York City) must provide State Plan services to any member who is eligible for them.

For more about the differences between 1915(c) HCBS waiver services and State Plan services, see the comparison chart below.

Part 2 - Overview of the 1915(c) HCBS Waivers in New York State

There are four active 1915(c) HCBS waivers in New York State. There are also others that have been withdrawn or terminated, which are not discussed here, but can be found using the CMS Waiver search tool, which is linked in Part 4 under “Federal Resources on 1915(c) HCBS Waivers.”[1]

A graphic showing the four waivers and the age limits for each, is below.

The four 1915(C) HCBS waiver programs are run by a variety of agencies. A graphic showing which agency administers each waiver, is below. (“OPWDD” stands for Office of People with Developmental Disabilities, “RRDC” stands for Regional Resource Development Centers, and “DOH” stands for the Department of Health. A December 2024 list of all RRDCs for the NHTD Waiver can be found here. An August 2022 list of all RRDCs for the TBI Waiver can be found here.)

The enrollment numbers for each waiver also vary. A graphic showing enrollment numbers by waiver, is below.

SOURCE OF DATA in above chart:

  • OPWDD Waiver enrollment data is from this October 2024 OPWDD document.
  • TBI Waiver and NHTD Waiver enrollment data comes from a February 2025 document from The Alliance of TBI & NHTD Waiver Providers, titled “Reject Executive Budget Proposal to Cap NHTD Waiver,” on file with NYLAG.
  • Children’s HCBS Waiver enrollment data comes from slide 12 of this March 2021 DOH slidedeck.

Other facts about the four 1915(c) HCBS waiver programs in New York:

  • Financial eligibility – There is no transfer penalty, or “look-back” period, for applicants to any of the HCBS Waivers in New York State. See DOH Office of Health Insurance Programs, GIS 07 MA/018 (Sept. 24, 2007). Also, married waiver participants may opt to use spousal impoverishment rules that can be advantageous and may eliminate the “spend-down” that would otherwise be imposed. NYS DOH GIS 12 MA/013 (2012) reinstates spousal impoverishment protections in the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver programs.
  • Adult HCBS waiver enrollees are not required to enroll in Medicaid Managed Care and Managed Long Term Care plans. Enrollees of the NHTD HCBS Waiver, the TBI HCBS Waiver, and the OPWDD Waiver are exempted from the statewide requirement to enroll into Medicaid Managed Care plans (for those without Medicare) and are excluded from enrolling in Managed Long Term Care (for those age 21+ who have Medicare). Those without Medicare have the option to enroll in Medicaid managed care plans but are not required to.

But children enrolled in the Children’s HCBS Waiver must still enroll into Medicaid Managed Care unless they fall into another exemption or exclusion category, such as having comprehensive third party health insurance through a parent (which would make them excluded from Medicaid Managed Care) or having been determined to have an Intellectual/Developmental Disability and thus having a code 95 on their ePACES (which would make them exempt from Medicaid Managed Care).

1. Traumatic Brain Injury (TBI) Waiver

As described by CMS on its Waiver Factsheet for New York State, the TBI Waiver provides an array of services, listed below,  to individuals with brain injury ages 18 or older who meet a nursing facility level of care. This waiver operates with a concurrent 1115 authority.

Eligibility for this waiver

Eligibility for this waiver includes:

  1. Be a recipient of Medicaid coverage that supports community based long term care services.
  2. Have a diagnosis of traumatic brain injury (TBI).
  3. Be between the ages of 18 and 64 upon application to the waiver.
  4. Be assessed to need a nursing facility level of care  (NFLOC) as a direct result of the traumatic brain injury. This is determined by the NFLOC score on the Uniform nursing Assessment that must be at least 5.
  5. Choose to participate in the waiver rather than reside in a nursing facility.
  6. Identify the residence in which the waiver participant will be living when receiving waiver services.
  7. Complete an Initial Service Plan and Application Packet in cooperation with a Service Coordinator and be approved by the RRDS.
  8. Have a completed Plan for Protective Oversight (PPO).

HCBS services offered under this waiver

The HCBS services offered under this waiver are:

  1. Service Coordination
  2. Independent Living Skills Training and Development (ILST)
  3. Structured Day Program (SDP)
  4. Substance Abuse Program (SAP)
  5. Positive Behavioral Interventions and Support Services (PBIS)
  6. Community Integration Counseling (CIC)
  7. Home and Community Support Services (HCSS)
      • Note: HCSS is similar to Personal Care Services! HCSS workers are trained as PCAs and can do Level I and Level II PCA tasks. Yet HCSS doesn’t require the client to go through the NY Independent Assessor (NYIAP)! And HCSS only has 24-hour care through split shift (not live-in), because the worker is required to stay awake during the service provision.
  8. Respite Services
  9. Environmental Modifications Service (E-mods)
  10. Environmental modifications (“E-mods”) for Vehicles
  11. Assistive Technology Services
  12. Transportation
  13. Community Transitional Services (CTS)

A detailed description of each service listed above can be found in Section VI of the Traumatic Brain Injury Program Manual – April 2009 (starting at page 51 of the PDF)

Additional resources about this waiver

  • Home and Community Support Services (HCSS) Letter (Apr. 29, 2009, requiring providers of Home and Community Support Services (HCSS) in the waiver to be licensed home care services agency (LHCSA).
  • GIS 12 MA/013 reinstates spousal impoverishment protections in the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver programs, in addition to Lombardi  (thus repealing NYS DOH GIS 08-MA-024, Aug. 26,2008 which eliminated spousal protections in TBI and NHTDW waivers). See more here.

2. Nursing Home Transition & Diversion (NHTD) Waiver

2026 ALERT – CAP ON ENROLLMENT:  Around Dec. 31, 2025, CMS  approved DOH’s request to amend the NHTD waiver to  cap the number of people who may enroll in the Nursing Home Transition & Diversion (NHTD) Waiver, without an option for a waiting list. See proposed amendment of the "waiver," issued in June 2025. NYLAG submitted these comments opposing the enrollment cap. Mobilization for Justice and other organizations also submitted comments opposing the cap. DOH summarized and responded to the comments in a notice published in the Dec. 3, 2025 State Register (see page 97).

As of Jan. 2026, enrollment is reportedly about 12,700 – already exceeding the approved cap of 9.400. Word is awaited from DOH about how the cap will affect current enrollees, current applicants in the queue, and prospective applicants.

About the Waiver. As described by CMS on its Waiver Factsheet for New York State, the NHTD Waiver provides a range of services (listed below) to individuals ages 65 or older and individuals with physical disabilities ages 18-64 years who meet a nursing facility level of care. This waiver operates with a concurrent 1115 authority.

Eligibility for this waiver

Eligibility for this waiver includes:

  1. Be between age 18 and 64 with a physical disability, or age 65 and older upon application to the waiver; if under age 65, the physical disability must be documented.
  2. The individual must identify a Home and Community Based (HCB) Settings compliant residence in which they will reside when receiving waiver services (meaning applicant must live in the community not an institution).
  3. The individual and/or their legal guardian must choose to participate in the waiver by indicating consent on the Freedom of Choice form.
  4. Be a recipient of Medicaid coverage that supports community-based long-term care services.
  5. Be assessed to need a nursing facility level of care (NFLOC) and live safely in the community. Like the TBI waiver, this requires a minimum NFLOC score of 5 on the Uniform nurse assessment.
  6. The applicant must select a Service Coordination provider who will assist the applicant in the completion and submission of an Application Packet, including the Initial Service Plan, in cooperation with the Service Coordinator. See 2025 DOH guidance describing the role of the Service Coordinator.
    1. Note that according to this DOH NHTD page, the RRDC must “provide the applicant a current list of available Service Coordination providers along with a Service Coordination Agency Selection form.”
  7. Included in the Initial Service Plan, the applicant must have a completed Plan for Protective Oversight (PPO).
  8. Informal supports and Medicaid state plan and waiver services must be sufficient to safely serve the individual in the community.
  9. Entrance to the waiver is further based on confirmation that the applicant chooses to participate in waiver services, completion of a service plan and applicable forms signed by the applicant, and confirmation that the applicant can be safely and appropriately cared for in a community setting.

HCBS services offered under NHTD waiver

The HCBS services offered under this waiver are:

  1. Service Coordination
  2. Assistive Technology (AT)
  3. Community Integration Counseling (CIC) Services
  4. Community Transitional Services (CTS)
  5. Congregate and Home Delivered Meals
  6. Environmental Modifications  (E-mods)
  7. E-mods for Vehicles
  8. Home and Community Support Services (HCSS)
      • Note: HCSS is similar to Personal Care Services! HCSS workers are trained as PCAs and can do Level I and Level II PCA tasks. Yet HCSS doesn’t require the client to go through NYIAP! And HCSS only has split shift (not live in), because the worker is required to stay awake during the service provision.
  9. Assessment Process
  10. Home Visits by Medical Personnel
  11. Independent Living Skills Training (ILST)
  12. Moving Assistance Services
  13. Nutritional Counseling/Educational Services
  14. Peer Mentoring
  15. Positive Behavioral Interventions and Supports (PBIS)
  16. Respiratory Therapy
  17. Respite Services
  18. Structured Day Program Services (SDP)
  19. Transportation Services (Social Transportation)
  20. Wellness Counseling Service

Additional resources about this waiver

You can learn more about this waiver through the following resources:

  • How to apply?     The State contracts with eight Regional Resource Development Centers (RRDC) that handle applications for both the TBI and NHTD waiver for designated regions. See the list of all regions and contact info for RRDCs on the DOH NHTD webpage, under the heading “Resources & Community Outreach” and the subheading “Regional Resource Development Centers (RRDCs).”

  • Contact Westchester Independent Living Center (WILC)'s NHTD teams. WILC is the RRDC for NYC and the Lower Hudson Valley for both the NHTD and TBI waivers. According to the WILC page about the NHTD waiver, the contact information is as follows:
    • NYC: For the New York City NHTD Waiver Program call 718-816-3555 for Bronx and Staten Island, call 914-685-5045 for Manhattan and Queens or call 914-685-5064 for Brooklyn.
    • Lower Hudson Valley: Contact Meghan Maldonado for NHTD RRDC information in the lower Hudson Valley (Westchester, Rockland, Orange, Sullivan, Putnam, Dutchess, Ulster) at mmaldonado@wilc.org or call 845-228-7457 ext. 1130 (voice), 914-259-8036 (VP).

3. Office for People with Developmental Disabilities (OPWDD) Waiver

As described by CMS on its Waiver Factsheet for New York State, the OPWDD Waiver “[p]rovides day habilitation, live-in caregiver, prevocational services, residential habilitation, respite, supported employment, community transition services, fiscal intermediary, individual directed goods and services, support brokerage, assistive technology/adaptive devices, community habilitation, environmental modifications (home accessibility), family education and training, intensive behavioral services, pathway to employment, and vehicle modification services to individuals with autism, intellectual disabilities, or developmental disabilities ages 0 or older who meet an ICF/IID level of care. This waiver operates with a concurrent 1915(a)(1)(a) and 1915(b)(4) authority.”

Eligibility for this waiver

Eligibility for this waiver includes:

  1. Have a developmental disability as defined by New York Mental Hygiene Law Section 1.03(22) that: originated before the age of 22; has continued or can be expected to continue indefinitely; and constitutes a substantial handicap to such person's ability to function normally in society;
  2. Need a Level of Care that would be provided in an Intermediate Care Facility for Individuals with Intellectual and/or Developmental Disabilities (ICF/IDD);
  3. Be a Resident of New York State and live in an appropriate living arrangement, as defined in 14 NYCRR 635-10.3(b)(5);
  4. Be in a Medicaid eligibility group that is eligible to enroll in Medicaid as described in the HCBS Waiver and defined in SSA §§ 1634(c) and 1902(a)(10)(A)(i) and (ii) and 42 CFR Part 435;
  5. Not be enrolled in another HCBS Waiver or a managed long-term care plan, as described in 42 CFR §433 Subpart D; and
  6. Meet the requirement of a Reasonable Indication of Need for Services as defined in 42 CFR §441.302(c) and described in the HCBS Waiver.

HCBS services offered under this waiver

The HCBS services offered under this waiver are as follows (see more about them on the OPWDD page titled Types of Services):

  1. Community Habilitation
  2. Day Habilitation
  3. Prevocational Services (Site-based and Community-based)
  4. Supported Employment (SEMP)
  5. Respite
  6. Assistive Technology – Adaptive Devices
  7. Environmental Modifications (Home Accessibility)
  8. Vehicle Modifications
  9. Residential Habilitation
  10. Community Transition Services
  11. Fiscal Intermediary (FI)
  12. Support Brokerage
  13. Individual Directed Goods and Services
  14. Live-in Caregiver
  15. Family Education and Training
  16. Intensive Behavioral Services
  17. Pathway to Employment

Service providers for each of the above OPWDD HCBS service can be found through the OPWDD Provider Directory.

For a 2023 breakdown of the spending for all OPWDD HCBS Waiver services, see the graphic below, which comes from page 12 of the October 11, 2024 OPWDD document titled OPWDD By The Numbers. (Although the red text boxes were added by NYLAG for clarity sake.)

For a 2023 breakdown of the spending on OPWDD’s Day and Employment Services specifically, see the graphic below, which comes from page 14 of the October 11, 2024 OPWDD document titled OPWDD By The Numbers.

Self Direction Budget - The OPWDD HCBS Waiver offers something called a “Self Direction” budget for OPWDD HCBS Waiver enrollees who apply and are approved for such a budget. Through a “Self Direction” budget, the enrollee is approved for a budget, from which the enrollee can pay for a variety of services. Of the 17 OPWDD HCBS Waiver services listed above, only six cannot be included in a “Self Direction” budget. The other services, and more, must be paid for using the budget. Below is a graphic, made by NYLAG, explaining the breakdown of which services must be included in a “Self Direction” budget for an  approved OPWDD HCBS Waiver enrollee. For a full chart of allowable Individual Directed Goods and Services (IDGS) expenses, see this 2022 OPWDD document. You can also watch the 57-minute YouTube video by OPWDD titled Self Directed Services Development of Life Plans and Staff Action Plans.

Services Included in Self-Direction Budget 

 

Additional resources about this waiver

You can learn more about this waiver through the following resources:

4. Children’s Waiver 

As described by CMS on its Waiver Factsheet for New York State, the Children’s Waiver provides services listed here to individuals with physical or other disabilities ages 0-20 with brain injury, HIV/AIDS, developmental or intellectual disabilities or autism, who are medically fragile or technology dependent. The waiver also covers individuals with mental illness ages 18-20, and individuals with serious emotional disturbance ages 0-18 years who meet a hospital, nursing facility, or ICF/IDD level of care. This waiver operates with a concurrent 1915(b)(4) and 1115 authority.

Prior to April 1, 2019, New York State had the following six 1915(c) Home and Community Based Services (HCBS) waivers for children. As NYSDOH explains on its Overview of 1915c Children’s Waiver and 1115 Waiver page, effective April 1, 2019, “the following six 1915(c) Home and Community Based Services (HCBS) waivers [were] consolidated into a single, 1915(c) Children’s Waiver.” The consolidation was further described in 19 OHIP/ADM-02 titled Consolidated Children’s Waiver and Medicaid Case Processing Requirements (May 10, 2019). The six consolidated waivers were:

  • Office of Mental Health (OMH) Serious Emotional Disturbance (SED) waiver #NY.0296;
  • Department of Health (DOH) Care at Home (CAH) I/II waiver #NY.4125;
  • Office for People with Developmental Disabilities (OPWDD) Care at Home waiver #40176;
  • Office of Children and Families (OCFS) Bridges to Health (B2H) SED waiver #NY.0469;
  • Office of Children and Families (OCFS) B2H Developmental Disability (DD) waiver #NY.0470; and
  • Office of Children and Families (OCFS) B2H Medically Fragile waiver #NY.0471.

The graphic below comes from slide 5 of these March 2021 DOH slides.

Eligibility for this waiver

Eligibility for this waiver includes:

  1. Children/youth must be under 21 years old and eligible for Medicaid to receive Children’s HCBS.
  2. Children’s HCBS eligibility is comprised of three components:
    1. target criteria,
    2. risk factors, if applicable, and
    3. functional criteria.
  3. Level of Care (LOC): Children/youth must meet institutional placement criteria. There are four target populations/subgroups for children/youth within the LOC group:
    1. Serious Emotional Disturbance (SED);
    2. Medically Fragile Children (MFC);
    3. Developmental Disability (DD) and Medically Fragile; and
    4. Developmental Disability (DD) and Foster Care.

Whether or not a child is found eligible for the Children’s Waiver, is ultimately documented onto the OHIP-0125 (12/24) form titled Children’s Waiver Eligibility.

HCBS services offered under this waiver

The HCBS services offered under this waiver are:

  1. Community Habilitation
  2. Day Habilitation
  3. Caregiver/Family Advocacy and Support Services (CFASS)
  4. Respite (both Planned and Crisis)
  5. Prevocational Services
  6. Supported Employment
  7. Palliative Care – Expressive Therapy
  8. Palliative Care – Massage Therapy
  9. Palliative Care – Counseling and Support Services
  10. Palliative Care – Pain and Symptom Management
  11. Adaptive and Assistive Technology
  12. Vehicle Modifications
  13. Environmental Modifications
  14. Non-Medical Transportation

Confused about the Children’s HCBS Waiver services compare to the services available to children through Early Intervention and/or the OPWDD HCBS Waiver? If so, check out the following comparison charts, which are amazing resources showing side-by-side comparisons for better understanding of the differences.

Additional resources about this waiver:

The main NYSDOH page with resources related to the Children’s Waiver is called 1915(c) Children’s Waiver and 1115 Waiver Amendments. On this website, you can find resources organized into the following categories:

Additional websites with resources related to the Children’s HCBS Waiver are below:

Part 3 - 1915(c) HCBS Waivers and EPSDT – the federal Medicaid protection for children

As mentioned in our article on the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children, EPSDT mandates coverage (for Medicaid enrolled children under 21 years old) of all medically necessary health care, diagnostic services, treatment, and other measures described in section 1905(a) of the Social Security Act. However, EPSDT does not mandate coverage of services not covered under section 1905(a). This means that EPSDT does not include services authorized through Social Security Act section 1915(c) – this includes the many Home and Community Based Services (HCBS) Waiver services listed under each of the four waivers described above.

Note that EPSDT still protects children enrolled in any of the waivers or programs listed above, to the extent those children are seeking section 1905(a) services. For example, Personal Care Services, Consumer Directed Personal Assistance Program (CDPAP) services, and durable medical equipment are not waiver services. Rather they are State Plan services under section 1905(a) of the Social Security Act, so must be made available to EPSDT-eligible children when medically necessary.

CMS SHO # 24-005 at pages 53-54 includes this helpful explanation of how section 1905(a) services and other services relate for children under 21 years old:

[U]nder section 1905(r)(5) of the Act, the EPSDT mandate includes coverage of any medically necessary service under section 1905(a) of the Act. States must determine whether any medically necessary services included on an EPSDT-eligible child’s PCSP are coverable as section 1905(a) services under EPSDT obligations before covering them under a 1915(c) HCBS waiver program, or a state plan option under 1915(i) (HCBS), 1915(j) (self-directed personal care services), or 1915(k) (Community First Choice). As a result, any 1915(c) waiver program services and state plan 1915 services that could be covered under a section 1905(a) benefit must be covered first as a section 1905(a) service for EPSDT-eligible children.

. . .

Additionally, CMS interprets section 1905(r)(5) to mean that a state’s decision to cover a section 1905(a) service under a section 1915 authority cannot be used to deny, delay, or limit access to medically necessary section 1905(a) services for which coverage is required under EPSDT.

An EPSDT-eligible child who is also eligible under a section 1915(c) waiver program or 1915 state plan benefit may need section 1905(a) services above and beyond what is medically necessary, to enable them to live in the community and avoid institutionalization. In this case, the child is entitled to all necessary services: those that are identified in their approved PCSP that assist the child to function in the home and community and avoid institutionalization via a section 1915(c) waiver program or section 1915 state plan authority, as well as any medically necessary section 1905(a) services under EPSDT. It is the responsibility of states to ensure that EPSDT-eligible children receive all services to which they are entitled.

Part 4 - Where to Find Free Legal Help  

  • NHTD Waiver:
    • Mobilization for Justice litigated the NHTD Class Action lawsuit titled Bagley et al. v. New York State Department of Health et al. To speak with Mobilization for Justice about their NHTD litigation, you can contact them via their main phone number, 212-417-3700, or via the information listed on their website here.
    • See a list of organizations on our New York Health Access Article titled “Getting Help with Managed Medicaid,” here: http://health.wnylc.com/health/entry/234/

  • OPWDD Waiver:
    • Disability Rights of New York (DRNY)’s P&A for People with Intellectual/Developmental Disabilities (PADD) team.
    • Community Service Society (CSS)’s Independent Intellectual and Developmental Disabilities Ombudsprogram (IDDO) program.
      • Website: https://iddony.org/
      • Phone: 800-762-9290 (open Monday-Friday from 9am-5pm)
      • Online contact form: https://iddony.org/contact-form/ 
      • Note (directly from IDDO website): “IDDO helps individuals with Intellectual and Developmental Disabilities also known as IDD, their caregivers, and providers navigate supports and services through the Office for People with Developmental Disabilities (OPWDD). . . . Here are some reasons you can contact IDDO for help:
        • I need to apply for OPWDD
        • I want to know my rights
        • I have a problem with my care manager, my program or my housing
        • I want to better understand what services I can get
        • I want to direct my services or learn more about Self-Direction
        • I think I need to report abuse or neglect
        • I do not agree with a decision that has been made about my Life Plan, Housing or other services”

Part 5 - Additional Resources about 1915(c) HCBS Waivers – and Legal Citations

For more about 1915(c) HCBS waivers, please visit the following resources. Each of the following resources is a trusted document, published either by the federal government, federal advisory committees, or leading national advocacy organizations with 1915(c) HCBS waiver expertise. The resources are arranged in chronological order, with the most recent resource at the top and the oldest resource at the bottom.

 

[1] One waiver program that closed is the Long Term Home Health Care Program (Lombardi/ LTHHCP, including the AIDS LTHHCP). See GIS 16 MA/011 - Closing the Long Term Home Health Care Program (LTHHCP) (PDF). Beginning  April 1, 2013, all adult participants age 21+ were required to enroll in a Managed Long Term Care plan for "dual eligibles" (have Medicare and Medicaid). That transition ended in 2016, when the Lombardi program closed. See MICSA Alert from NYC HRA regarding this mandatory transition.

Tags
NHTDW TBI TBI waiver Nursing Home Transition home and community based services care at home
Attached files
item NYLAG comments NHTD Waiver Cap Final with Attachments.pdf (3.26 mb) Download
item 2013-04-18 lombardi mltc.pdf (102 kb) Download
item Medicaid Waivers Outline.pdf (221 kb) Download

Also read
item Medicaid Personal Care or Home Attendant Services
item The Various Types of Medicaid Home Care in New York State
item "HARP" Plans for Managed Care Members who need Behavioral Health Services - 2026 Changes for Members New to Medicare
item Medicaid Certified Home Health Agency (CHHA) Services
item Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections
item Managed Long Term Care
item Medicaid Managed Care
item Spousal Impoverishment Protections for Married Couples - If One Spouse is in MLTC, Waiver or Immediate Need - Can use Pooled Trust

Also listed in
folder Medicaid -> Home Care -> Types of Medicaid Home Care in NYS

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