Changes to Care Management Services for Children’s Waiver Home and Community-Based Services (HCBS)

What You Need to Know:

• Prior to January 1, 2026, Children’s Waiver HCBS eligibility determinations for members not already enrolled in Medicaid were completed by Maximus, a contractor of the New York State (NYS) Department of Health (DOH) responsible for performing Children and Youth Evaluation Services (C-YES) functions.
• Effective January 1, 2026, the NYS DOH will be responsible for determining initial Children’s Waiver eligibility for children/youth not already enrolled in Medicaid.
• During a transition period that began January 1, 2026, to March 31, 2026, children who are already enrolled in Medicaid will be referred to a Health Home/Health Home Care Management Agency for a Children’s Waiver eligibility determination.
• By March 31, 2026, members who currently receive HCBS care coordination services through C-YES will be referred to a Health Home to determine their new HCBS care coordination provider.
• Effective April 1, 2026, onwards, Children’s Waiver recipients will no longer receive care management services from Maximus/C-YES.

Questions?

If you have any questions about this memo, please call our Member Services at 1.800.303.9626 (TTY: 711).

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