Home and Community-Based Services (HCBS)


HCBS offer support to children, youth, and families that enables children to remain at home and in the community.

Services are individualized to meet the health, developmental, and/or behavioral health needs of each child/youth. These services are provided in a flexible, complimentary package that evolves over time to meet the changing needs of children. HCBS are intended to be provided to a child and family in their home and/or the community; HCBS can also be part of discharge planning for children/youth returning home.

Eligibility Requirements

  • Children/Youth must be under 21 years old
  • Eligible for Medicaid (If you or your child do not already have Medicaid, please contact The Children and Youth Evaluation Service (C-Yes) at 1-833-333-CYES (1-833-333-2937)
  • A Health Home Care Manager or C-Yes must complete an HCBS eligibility assessment
  • The Children and Youth Evaluation Service (C-YES) is a statewide program that determines whether a child/youth (under age 21) is eligible for Home and Community Based Services (HCBS) for children who do not currently have Medicaid or for children who opt-out of the Health Home Serving Children’s program.

Target Population

  • Children with Serious Emotional Disturbance (SED)
  • Children with a Developmental Disability (DD) in Foster Care
  • Children who are Medically Fragile (MedF)
  • Children who are Medically Fragile (MedF) with a Developmental Disability (DD)

Services

The array of services is intended to assist children/youth in being successful at home, in school, and in their other natural environments to help maintain them in their community and avoid higher levels of care and out-of-home placements.

  • Community and Family Supports – assistance in navigating complex systems (i.e. schools, hospitals); advocacy/access for needed resources; support with complex family dynamics; community-based skills training for children/youth; transitional support
  • Employment Services – youth build job-ready skills that can be used in any work environment; specific skills training up to and including job shadowing
  • Planned Respite – planned breaks for caregivers and their children; use of time can include skill-building and/or recreation

Referral Process

A Health Home Care Manager or The Children and Youth Evaluation Services (C-Yes) must complete an HCBS referral form and submit it to ManagedCareReferrals@elmcrest.org. Other documents needed at time of referral include: Consent to Share Information, Notice of Decision, and primary diagnosis.

Contact

For questions or more information, please contact:
Kelly Ocampo (Director of HCBS) p. 315-546-4127 e. kedmonston@elmcrest.org

Children and Family Treatment Support Services (CFTSS)


These services are designed to assess for mental health and substance abuse, identify strengths and abilities, provide therapy where children and families are most comfortable, learn to incorporate therapy goals into everyday life, build relationships, and learn self-care and coping skills to manage emotions.

Eligibility Requirements

  • Children/Youth must have or be eligible for Medicaid and/or enrolled in Medicaid Managed Care, and in a home or community-based setting.

Target Population

  • Children 0-21 years old that have social, emotional, and/or behavioral health needs.

Services

We provide three main services for children and families.  Clients can receive any and all services below based on need and medical necessity.

Other Licensed Practitioner / Licensed Clinician (OLP)

  • Therapy can be provided in the home- individual, family, etc. Youth that have a treating therapist in clinic can still receive this service but it cannot be a duplication of service.
  • Evaluations and Assessments

Community Psychiatric Supports and Treatment (CPST)

  • Identify skills for future crisis and identify precursors or triggers. Supports youth/family after a crisis .
  • Provide education to youth, family members or collaterals to maintain youth in the community (Example: triggers, coping skills etc.)
  • Assist the youth, family and collaterals to identify resources in the community, associated with the identified needs.
  • Improving life skills-making appointments, access to emergency services, basic safety practices, etc.

Psychosocial Rehabilitation (PSR)

  • Increase social and interpersonal skills, daily living skills and community integration.

Referral Process

Anyone can make a referral for CFTSS. Submit to ManagedCareReferrals@elmcrest.org.

Contact

For questions or more information, please contact:
Danielle Janowsky (Director of CFTSS Program) p. 607-624-1629 e. djanowsky@elmcrest.org

Health Home Care Management


Health Home Care Management is a community-based service model whereby all of a child’s caregivers and providers communicate with one another so that all of a child’s needs are addressed in a comprehensive manner. This is done primarily through a Health Home Care Manager who oversees and provides access to all of the services a child needs to ensure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital.

The Health Home program also serves as a gateway to Home and Community-Based Services (HCBS) for children that are at risk of being removed from their homes.

Eligibility Requirements

  • Children/Youth from birth to age 21
  • Must be enrolled in Medicaid
  • Must meet one of the following criteria for eligibility:
    • Serious Emotional Disturbance (Axis 1 Diagnosis)
    • Two Chronic Conditions (Only one of which can be a developmental diagnosis)
    • HIV/AIDS
    • Complex Trauma (client will be assessed for this in the absence of a diagnosis in one of the above categories)
    • Must have functional limitations related to their eligibility criteria
    • Sickle Cell Disease

Target Population

  • Children/Youth from birth to age 21

Services

The Health Home Care Manager shares health records among providers so that services are not duplicated or neglected. 

The core services include:

  • Comprehensive Health Home Care Management
  • Care Coordination and Health Promotion
  • Comprehensive Transitional Care
  • Individual and Family Support
  • Referral to Community and Social Services

Referral Process

Any parent/guardian, community member, or service provider can make a referral, with consent from the client’s medical consenter. Submit to ManagedCareReferrals@elmcrest.org.

Contact

For Questions or more information, please contact:
Krysten Downey (Direct of Health Home Care Management) p. 315-463-9415 ext. 12 e. kdowney@elmcrest.org