Medicaid changes which began taking effect on January 1 impact the way certain children in the foster care system receive medical and behavioral health services. These changes are part of a phasing in of new rules that will affect most children in foster care by January 1, 2019.
The goal is to simplify the number of waivers currently used to provide Home and Community Based Services (HCBS) to children. Beginning on January 1, 2018, the authority for the provision of HCBS provided under the following six 1915(c) waivers will transition to the 1115 Waiver:
o SED 1915(c) waiver (NY.0296)
o DOH Care at Home (CAH) I/II 1915(c) waiver (NY.4125)
o OPWDD Care at Home 1915(c) waiver (NY.40176)
o OCFS Bridges to Health (B2H) SED 1915(c) waiver (NY.0469)
o OCFS B2H Medically Fragile 1915(c) waiver (NY.0471)
o OCFS B2H DD 1915(c) waiver (NY.0470)
This means that, with the exception of children served by Voluntary Agencies, children currently receiving services under any of the above six waivers will no longer be enrolled in fee for service Medicaid. Instead, they will receive services through the Medicaid Managed Care Delivery System.
As part of the transition, by July 1, 2018, children in foster care must be enrolled in a Medicaid Managed Care Plan (MMCP) and receive services through the Medicaid Managed Care Delivery System.
By January 1, 2019, children in care of a Voluntary Foster Care Agency must be enrolled in a Medicaid Managed Care Plan and receive services from the Managed care delivery system. Additionally, a new population called at-risk HCBS level of need (LON) population must do the same.
Children/youth who are otherwise excluded from enrollment in a Medicaid Managed Care Plan, will continue to receive Medicaid benefits, including Health Home care management, the six new State Plan services and the aligned children’s HCBS, from the Medicaid fee-for-service delivery system.
Children/youth who are otherwise exempt from enrollment in a Medicaid Managed Care Plan will continue to have the option of enrolling in an MMCP or receiving Medicaid benefits from the Medicaid fee-for-service delivery system.
Special Rules for Voluntary Foster Care Agencies
Voluntary Foster Care Agencies (VFCA) will transition to the Medicaid Managed Care system on a different schedule. All VFCAs will continue to bill Medicaid as they do now for the daily rate for each foster child.
NOTE: Each VFCA must go through a new licensing process with the state prior to January 1, 2019 in order to select and enroll foster children in the Medicaid Managed Care Plan. At the same time, the state will determine the ‘residual per diem’ rate to be paid to the VFCA by Medicaid Managed Care for those specific costs that are not included in the capitated rate.
This residual per diem rate will primarily cover staffing costs.
• All children in Foster Care will be mandated to enroll in Medicaid Managed Care (unless otherwise exempt or excluded from Medicaid managed care)
• Continuity of care will be monitored and children will access needed services through interim care
Billing Transition Summary
During the transition period, Medicaid will crosswalk 1915 (c) services rate codes with the new 1115 rate codes. In addition, both Fee for Service (FFS) and Medicaid Managed Care Plans will accept the 1115 rate codes during the transition. Care managers transitioning from 1915 (c) to Health Homes have received a transitional rate.
Read the full text of the Final Draft Transition Plan for the Children’s Medicaid System Transformation, released November 14, 2017. You can also learn more from the New York State Department of Health’s
Website: visit the VCFA section or the 1115 Waiver Section for further details.
Still Have Questions?
Fulton Street Software can help you navigate this transition. Its expert team is available to discuss the upcoming changes and can show you how its software solutions, custom designed by and for New York State Child Welfare Agencies, can provide you with a seamless solution for billing, case management and more. Contact us.