Home and Community-Based Services Waiver Program "Bridges to Health" (B2H)

About the B2H Program

New York State Office of Children and Family Services is pleased to announce the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services approved the B2H Home and Community Based Services Waiver applications on July 19, 2007. The B2H Program will be effective January 1, 2008.

B2H Rates

The New York State Office of Children and Family Services (OCFS) and the New York State Department of Health are pleased to announce the approved rates for the Bridges to Health (B2H) Medicaid Home and Community-Based Services Waiver Program. Approved Rates for B2H Waiver Program effective January 1, 2008 (PDF)

B2H Design Development

Throughout the waiver development process, multiple meetings were conducted with a variety of stakeholders to permit creation of a program design appropriate to the needs of children in foster care and their family/caregivers. These meetings were held with stakeholders that included children in foster care, parents of children in foster care, adoptive parents, clinicians, Local Departments of Social Services, foster care providers and representatives from New York state agencies, including the Department of Health, Office of Mental Health, Office of Mental Retardation/Developmental Disabilities, and Office of Alcoholism and Substance Abuse Services.

B2H Program Elements

The B2H program will provide family and community support services to a proposed 3,305 children statewide that will supplement, not replace, the existing foster care and Medicaid State Plan programs. The roll-out is planned over three years beginning January 2008.

The B2H waiver application recognizes these children's special circumstances in several ways:

• The family network that will be able to be served along with the child can involve multiple families simultaneously, e.g. foster parents, biological parents, pre-adoptive parents;
• A child can qualify for waiver entry only while in foster care. However, once in the waiver, the participant can generally retain the services until age 21, as long as they meet waiver eligibility. To enhance their opportunities for successful reunifications and placements, the services can follow the participant home, into adoption, to lower levels of foster care and to adulthood;
• Many foster children have multiple disabilities which no single system serves well. The waivers serve three eligibility groups of children in foster care, so that cross-systems issues can be better integrated;
• Health care integration agencies (HCIAs) are qualified to participate in B2H only if they are foster care providers with experience in serving people with disabilities. This design element is intended to intertwine health planning with a recognition of the child's post-foster care permanency goal;
• Individualized Health Plans, which specifies the child's goals and the services necessary to maintain the child in his/her home community, is paramount in order to address singular traumatic events a child in care can experience, such as identifying, intervening and following through a crisis situation.

Federal Requirements

CMS evaluates the fiscal viability of waiver proposals based on a comparison of the cost of an institutional placement versus the total Medicaid State Plan and waiver spending for the participants. We anticipate that this waiver will meet this requirement and provide expanded services to children in foster care and those discharged while in the B2H program.

Background

Evidence is growing that children in foster care – children who can no longer receive parental care – suffer severe emotional, developmental and health disabilities at higher rates than the general population. For example, one study found that children in foster care exhibit post-traumatic stress disorder at twice the rates of combat veterans. Even when they can be returned home, the return is fragile. The NYS foster care caseload approaches 27,000. Research and work with local social services districts lead to estimates that 8,000 of these children could be eligible for the federal Home and Community-Based Services (HCBS) program.

The federal HCBS program permits states to receive federal Medicaid funding while waiving certain existing rules. In contrast to the existing program, HCBS waivers offer the opportunity to:

• target services to specific groups
• offer non-Medicaid services
• design services in new ways, e.g. permitting services to follow the child
• offer services otherwise allowed only in an institutional setting

The development of B2H was authorized by legislation directing the New York Department of Health (the state's Medicaid agency) to work with the Office of Children and Family Services to apply for waiver(s) to serve children in the care and custody of local departments of social services and OCFS. OCFS designed a foster-care-specific waiver application, known as B2H, to serve children with serious emotional disturbances, developmental disabilities and medical fragility. DOH submitted it to the Federal government on October 20, 2006.

On April 27, 2007, the Office of Children and Family Services (OCFS) and the state Department of Health submitted three revised waiver applications to the federal Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS):

• B2H for children with Serious Emotional Disturbances (SED)
• B2H for children with Developmental Disabilities (DD) and
• B2H for children with Medical Fragility (Med F),

These submissions were in response to DHHS CMS's Request for Additional Information (RAI) to separate the initial waiver application into the three applications into three disability groups of children to be served. OCFS will operate the three waivers as a single program.