CMS approved New York’s ‘Medicaid Redesign Team’ 1115 waiver amendment request on Jan. 9, 2024, which includes recuperative care as an allowable health-related social need (HRSN) service. Individuals who 1. are homeless or at imminent risk of homelessness, 2. are transitioning out of institutions, and 3. who are at risk of incurring other Medicaid state plan services (such as inpatient hospitalizations or emergency department visits) are eligible to receive medical respite services.
Recuperative care may be offered for up to 90 days once every 12 months (assessed on a rolling basis). Further, programs are required to have appropriate clinicians who can provide medical and/or behavioral health care, and the facility cannot be primarily used for room and board without the necessary additional support services.
New York state is unique in that it requires a program certification process and is required from the New York State Department of Health for programs seeking Medicaid reimbursement. Although programs have been able to apply for reimbursement as of January 1, 2025, the slower rollout of the implementation infrastructure, along with state-level certification requirement, most programs have not yet been able to obtain Medicaid reimbursement.
