Get ready to apply
New York State Department of Health
1915(c) Children’s Waiver Home and Community-Based Services
What you get
Assessed home and community services, including respite, family advocacy, comfort care, and help with everyday skills. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- Online, on their website
- Your time
- About 30 minutes
- Last checked
- Aug 27, 2026
Before you start, check you fit
- Your child is 20 or under.
- Medicaid, disability, functional, and institutional-risk findings are required.
- Cancer is an included medically fragile diagnosis, but diagnosis alone does not meet waiver eligibility.
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open their application ↗ Checked Aug 27, 2026What the form asks for
Medicaid coverage and conditionsDoes the child/youth you are referring currently have active MedicaidThe child/youth currently have the following (check all that apply)Child and referral detailsFirst Name / Last NameDate of BirthChild/Youth AgeCounty of ResidenceChild's/youth's sex assigned at birthWhat is the family's preferred languageDo you need language interpreter servicesReferent First Name / Referent Last Name / Email Address / Telephone Number / Title/Relationship to Child/YouthAre you the parent or legal guardian of the child/youthPrimary and second parent/guardian first name, last name, type, email, and phone numberDid someone refer you here or tell you the Children's Waiver / Home and Community Based Services (HCBS) would be helpful. If Yes, provide who referred you and whyBrief summary of why you are completing this referralWhat are the needs of the child/youth you are referringOther information you think might be importantWhat is the best time of day to contact youReferral permission · your care team fills this inIf you are not the parent, caregiver, or legal guardian, have you received permission from the parent, caregiver, or legal guardian to submit this referral on the child's behalf
After you send
If an email address was provided, keep the receipt message. C-YES staff will follow up; call 1-833-861-4467 if assistance is needed.