YES Waiver Brief Overview Courtney Seals – Manager Mark Catalano – YES Waiver Team Lead

What is the YES Waiver? Youth Empowerment Services (YES) is a 1915(c) Medicaid Mental Health Waiver program Provides community-based services to help children and youth with serious emotional disturbances in lieu of institutionalization Services include non-traditional therapies which supplement services provided through the State Plan

YES Waiver Goals Reduce the amount of time the child is out of their home and community because of a mental health need; Extend the range of mental health services and supports available for children with this level of need; Prevent entry into the foster care system and relinquishment of parental custody; and Improve the lives of children and youth served. 8/10/2019

YES Waiver Timeline Started as a pilot in 2010 Statewide in 2015 Started as a pilot in Travis and Bexar counties in 2010, Tarrant was added in 2012. Legislative direction required that the program be rolled out statewide in 2015, but it wasn’t until 2016 that programs were actually in place across the state The original pursuit of the waiver came about as a result of children being relinquished into state custody due to lacking MH services in the community. For this reason, when the waiver began, kids in DFPS care were disallowed from participation as the intent was to prevent entry into the DFPS system. However, the thinking evolved and this policy changed in 2016. Started as a pilot in 2010 Statewide in 2015 Foster care included in 2016 8/10/2019

Eligibility Requirements YES waiver participants are permitted to be dually enrolled in the Community First Choice program. General requirements for an individual to participate in the YES Waiver include: Meet demographic criteria; Meet clinical eligibility criteria; A reasonable expectation must exist that, without Waiver services, the individual would qualify for inpatient care under the Texas Medicaid Inpatient Psychiatric Admission Guidelines; and Choose, or have the Legally Authorized Representative (LAR) choose, the Waiver as an alternative to care in an inpatient psychiatric facility. An individual cannot be dually enrolled in, nor receive services from, another 1915(c) or 1915(i) program 8/10/2019

Demographic Criteria Ages of 3-18 Must reside in: Medicaid determination is made based on only the income of the youth, caregiver income NOT included Ages of 3-18 Must reside in: A non-institutional setting with the youth’s LAR; The youth’s own home or apartment, if legally emancipated; and 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 8/10/2019

Dual Program Enrollment Not Allowed Another policy section I would like to discuss is the Dual Program Enrollment Not Allowed policy which states that an individual cannot be dually enrolled in an IDD waiver and the YES Waiver program. This is critical because enrolling a participant into YES Waiver who was already enrolled in an IDD waiver, will result in them being dropped from the IDD waiver. This might not be common knowledge to the LAR and/or individual, which is why this information should be shared during intake. It is also important to discuss the service array that the YES Waiver program offers participants and how services are determined. The YES Waiver is not intended to be the program to enroll in while waiting for access to IDD programs and cannot offer the sole service of Respite to the participant and their LAR as it is not a Respite only program. With the limited slots the YES Waiver program has available, we need to ensure that those enrolled in the waiver are committed to this higher level of intensity treatment model and its services. In order to participate in the Waiver, an individual cannot be dually enrolled in, nor receive services from, another 1915(c) or 1915(i) program, including, but not limited to the:  Texas Health and Human Services (HHSC) Waiver programs: Community Living Assistance and Support Services (CLASS); Home and Community-Based Services (HCS/HCBS); Medically Dependent Children Program (MDCP); Consolidated Waiver Program (CWP); Deaf Blind with Multiple Disabilities (DBMD); Community-Based Alternatives (CBA); or Texas Home Living (TxHML). HHSC 1915(i) programs, including Home and Community-Based Services—Adult Mental Health (HCBS-AMH). STAR PLUS Community-Based Waiver. Reference: YES Waiver Policy Manual Section 2000 7

Clinical Criteria If demographic criteria is met, an individual will then be assessed based on the following clinical criteria. All criteria must be met to establish a need for this clinical level of care. The child or youth: Meet clinical and functional criteria determined through the Child and Adolescent Needs Assessment Outpatient therapy or partial hospitalization has been attempted and failed or a psychiatrist has documented reasons why an inpatient Level of Care is required Meet Texas Medicaid Inpatient Psychiatric Admission Criteria Must have a primary mental health diagnosis 8/10/2019

Inquiry Process LAR or Managing Conservator calls the local mental health authority (LMHA) YES Inquiry Line LMHA returns call within one business day Youth is placed on Inquiry List Assessment scheduled within seven business days of call. Must be attended by youth and LAR/Managing Conservator (CPS caseworker is strongly encouraged to attend) 8/10/2019

Enrollment Any client who is found eligible for YES Waiver is enrolled for 1 year. Assessments are conducted annually to review ongoing eligibility and remain in the program past 1 year. There is not a time limit for individuals to receive waiver services, assuming they continue to meet criteria at annual renewal and have not exceeded the age limit.

Enrollment Once enrolled, a client is eligible to receive YES Waiver specific services such as specialized therapies which are intended to supplement traditional mental health services provided through the Texas State Medicaid Plan

Service Delivery Child and Family Teams include natural and formal supports Services must be listed on the individual’s plan of care and they must be tied to a client’s mental health need and/or reason for referral to the YES Waiver program. Services are: Decided upon collaboratively using the “Wraparound Process” in Child and Family Team meetings Reviewed monthly to assess continued need of specific services and modified as needed Reviewed by HHSC to ensure that federal Medicaid policy has been met Flexible funding services require pre-authorization prior to delivery.

Service Breakdown YES Wraparound Texas Resiliency and Recovery Children in YES waiver have access to all of the TRR state plan services They also have access to wraparound using the state plan service/ICM. Wraparound is the evidence-based care coordination model use to coordinate the YES waiver services as well as any other formal and natural supports. Children in the waiver also have access to the YES waiver service array. Service Breakdown YES Wraparound Texas Resiliency and Recovery (State Plan Services) Deemed eligible via Children and Adolescent Needs and Strengths assessment (CANS) YES Services are specific to expanded service array (e.g. paraprofessional, art therapy, and respite) Follow National Wraparound Implementation Center model to provide wraparound using state plan ICM/TCM Services 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

What is Wraparound? Evidence-based process and approach to care planning that utilizes a team approach The team is made up of both natural and formal supports Process draws upon the strengths and resources of all team members Team meets on a monthly basis to review plan of care and determine services needed (referred to as the Child and Family Team Meeting) Youth and family meet regularly (most often on a weekly basis) with the Wraparound Facilitator 8/10/2019

YES Waiver Service Array Respite (in-home & out-of-home) Adaptive Aids and Supports Community Living Supports Family Supports Minor Home Modifications Non-Medical Transportation Supportive Family- Based Alternative Paraprofessional Services Specialized Therapies Animal Assisted Therapy Art Therapy Music Therapy Recreational Therapy Nutritional Counseling Supported Employment Employment Assistance Transitional Services 8/10/2019

Questions? 8/10/2019

Thank you! 8/10/2019