YES Waiver 101
Youth Empowerment Services
A Medicaid Waiver Program for
Children with Severe Emotional Disturbances
Texas Health and Human Services
YES Waiver
•
Youth Empowerment Services (YES) serves
to prevent or reduce institutionalization of
children and adolescents ages 3 – 18 with
Serious Emotional Disturbance (SED).
•
The YES Waiver enables more flexibility in
providing intensive community-based
services for children and adolescents with
SED, and provide support for their families
by improving access to services.
•
The YES Waiver is administered under Social
Security Act §1915(c) which allows for a
child to receive long-term care services
within the home and community based
settings.
History
• April 2010-March 2013: Pilot phase with
three sites
• April 2013-April 2015: Six sites added
• April 2015-April 2016: Statewide
expansion
Goals of YES Waiver
• Reduce and prevent out-of-home placements by all
youth-serving agencies
• Prevent or reduce inpatient psychiatric admissions for
children and adolescents with SED
• Provide a more complete continuum of communitybased services and supports for youth with SED and their
families
• Ensure families have access to parent partners and other
flexible non-traditional support services identified in a
family-centered planning process
• Prevent entry and recidivism into the foster care system
and relinquishment of parental custody
• Improve the clinical and functional outcomes of children
and adolescents with SED
General Eligibility
Requirements
• Between the ages of 3-18
• Must reside in:
o A non-institutional setting with the youth’s legally authorized
representative (LAR), or
o The youth’s own home or apartment, if legally emancipated, or
o If youth is in a private residential facility and has a discharge date
pending within the next 30 days, an intake can be completed
• Be eligible to receive Medicaid, under a Medicaid
Eligibility Group included in the Waiver
• May not be a recipient of other 1915(c) or 1915(i)
Waiver programs
Clinical Eligibility Criteria
• Criteria A: Score within specified range on CANS for
developmental domain
• Criteria B: Score within specified range on CANS for
specified child risk, caregiver strengths and needs, and
life domain functioning
• Criteria C: Must have attempted outpatient therapy or
partial hospitalization or have documentation by a
psychiatrist as to why inpatient care is required
• Criteria D: Must be reasonably expected to qualify for
inpatient care under the Texas Medicaid inpatient
psychiatric admissions guidelines
• Criteria E: Have a valid mental health diagnosis as the
principle admitting diagnosis (Axis 1)
Entry in to Services
• Legally Authorized Representative (LAR) calls the
Inquiry Line
• LMHA returns call within one business day
• Youth is placed on Inquiry List
• Assessment to be scheduled within seven business
days of call
Service Breakdown
YES
• Deemed eligible via Clinical Eligibility Assessment
• YES Services are specific to expanded service array (i.e.
Paraprofessional, Art Therapy, and Respite)
• Conduct Individual Plan of Care (IPC) review every 90
days for authorization of services
• Utilize CMBHS to enter YES specific documentation (CE,
IPC, and YES service array service notes)
Wraparound
•Follow National Wraparound Implementation Center
model to provide wraparound using state plan ICM/
TCM Services
•Utilize support of Texas Institute for Excellence in
Mental Health
•Model guidelines are congruent with TAC guidelines
TRR (State
Plan Services)
•Guidelines established by TAC, Title 25
•Complete CANS Assessment at initial and every
90 days, always requesting a deviation to LOC-YES
•LOC-YES includes all TRR state plan services
•Youth is entitled to all state plan services, which
includes required ICM/TCM services for YES Waiver
YES Service Array
•
Respite (In-Home & Out-Of-Home)
•
Paraprofessional Services
•
Adaptive Aids and Supports
•
•
Community Living Supports
•
Family Supports
Specialized Therapies
o Animal Assisted Therapy
o Art Therapy
o Music Therapy
o Recreational Therapy
o Nutritional Counseling
•
Minor Home Modifications
•
Supported Employment
•
Employment Assistance
•
Transitional Services
•
•
Non-Medical Transportation
Supportive Family-Based
Alternative
*The types of YES Waiver services may vary depending upon which Waiver Provider is selected*
YES Contact Information
Department of State Health Services
[email protected]
http://www.dshs.texas.gov/mhsa/yes