MMCP regarding non-risk minimum payment for Children's Waiver Home and Community Based Services

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Notification to Medicaid Managed Care Plans (MMCPs) regarding non-risk minimum payments for Children’s Waiver Home and Community Based Services (HCBS)

TO: Medicaid Managed Care Plans (MMCPs), including Mainstream Medicaid Managed Care and HIV Special Needs Plans

DATE: August 29, 2023

The New York State Department of Health (NYSDOH) requires that MMCPs pay government rates (otherwise known as Medicaid fee-for-service rates) for Children’s HCBS provided to children/youth enrolled in MMCPs. Effective October 1, 2019, the date HCBS were included in the Medicaid Managed Care benefit package, MMCPs were required to pay, at minimum, government rates for 24 months. Due to the Public Health Emergency, NYS extended the requirement for MMCPs to pay government rates without a specific end date.

Per this notice, NYSDOH has extended the deadline required for MMCPs to pay government rates for Children’s HCBS effective for dates of service through March 31, 2024. MMCPs will continue to be reimbursed via non-risk payments for Children's HCBS while this requirement is in effect. MMCPs should continue to submit claims for Children's HCBS with dates of service on or before March 31,2024 to eMedNY via the established rate codes.

Questions related to this notification can be sent to