New York - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New York State Department of Health (DOH) and the Office of Mental Health (OMH) fund tenancy support and housing retention primarily through Community Transitional Services (CTS) under the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) 1915(c) waivers, as well as through Adult Behavioral Health (BH) Home and Community Based Services (HCBS). New York does not use the standalone term "Housing Stabilization" as a distinct state plan service, instead bundling housing search, landlord mediation, and retention planning into these designated waiver and behavioral health authorities.

Agencies seeking to provide these non-licensed HCBS must first obtain a Formal Designation Letter from the NYS Interagency Designation Team before they can enroll in the Medicaid Management Information System (MMIS). Newly established agencies formed with the sole purpose of providing HCBS are structurally blocked from applying; the state requires a minimum of five years of operating experience before an application for designation is even considered.

1. Service Definition and Scope

In New York, tenancy support is delivered via Community Transitional Services (CTS) and Behavioral Health HCBS Habilitation/Psychosocial Rehabilitation. These services assist Medicaid beneficiaries in transitioning from institutional settings to the community and maintaining their tenancy once housed.

The scope of allowable activities focuses on the logistical and interpersonal skills required to secure and keep housing, explicitly excluding the payment of rent or room and board.

• Housing Search: assisting participants in locating affordable, accessible housing options in their preferred communities
• Application Assistance: helping individuals complete lease applications, secure necessary identification, and apply for housing subsidies
• Landlord Mediation: communicating with property managers to resolve disputes, negotiate lease terms, and prevent evictions
• Retention Planning: developing individualized strategies for independent living, budgeting, and home maintenance
• Excluded Costs: Medicaid funds cannot be used for monthly rent, utility payments, or ongoing room and board expenses
• Target Population: individuals enrolled in the NHTD waiver, TBI waiver, or Health and Recovery Plans (HARPs) meeting HCBS eligibility

2. Regulatory and Oversight Agencies

Oversight of housing-related HCBS in New York is shared across multiple state departments depending on the target population. The Department of Health manages the overarching Medicaid program and specific physical disability waivers, while the Office of Mental Health oversees behavioral health supports.

The Interagency Designation Team acts as the centralized gatekeeper for approving non-licensed HCBS providers across these populations.

• New York State Department of Health (DOH): oversees the NHTD and TBI waivers and general Medicaid policy (https://www.health.ny.gov)
• New York State Office of Mental Health (OMH): regulates Adult Behavioral Health HCBS and HARP services (https://omh.ny.gov)
• NYS Interagency Designation Team: reviews and approves applications for non-licensed HCBS provider designation (https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/hcbs_faqs.htm)
• eMedNY: serves as the state's Medicaid Management Information System (MMIS) for provider enrollment and claims (https://www.emedny.org)

3. Gatekeeping Prerequisites: Who Can Even Apply

New York imposes strict structural prerequisites on agencies attempting to enter the HCBS market. The state utilizes a designation process rather than traditional facility licensure for these specific community-based services.

Applicants must prove an established history of service delivery; shell companies or brand-new entities are explicitly barred from the designation process.

• Five-Year Operating History: newly established agencies cannot apply; applicants must demonstrate at least five years of experience providing relevant services
• Interagency Designation: providers must be approved by the NYS Interagency Designation Team before eMedNY will accept a Medicaid enrollment application
• Letters of Support: applicants lacking an existing government contract must submit at least two formal letters of support from established community organizations
• Medicaid Good Standing: agencies that are already enrolled in Medicaid for other services must be in good standing with no active sanctions
• Managed Care Contracting: for BH HCBS, providers must eventually secure contracts with Medicaid Managed Care Organizations (HARPs) to receive referrals

4. Licensure and Certification Requirements

Because tenancy support and CTS are non-clinical, community-based services, New York does not issue a traditional facility license. Instead, the state uses a two-tiered designation certification process.

Providers must navigate from a preliminary approval to a formal certification, which is contingent upon successful Medicaid enrollment.

• Non-Licensed Status: CTS and housing support HCBS do not require a Department of Health facility license (such as an Article 28 or Article 36 license)
• Preliminary Designation Letter: issued by the state when an agency meets the programmatic requirements but is not yet actively enrolled in eMedNY
• Formal Designation Letter: granted only after the agency successfully obtains an active MMIS ID; required before any services can be delivered
• HCBS Settings Final Rule Compliance: agencies must attest and demonstrate that their service delivery models comply with federal community integration standards
• Unique Documentation: all submitted policies and procedures must be unique to the agency; the state rejects applications using unmodified consultant templates

5. Medicaid Provider Enrollment

Once a Preliminary Designation Letter is secured, the agency must enroll as a billing provider through eMedNY. This process links the state's programmatic approval with the fiscal system.

Providers must enroll under specific Categories of Service (COS) that correspond to the HCBS waivers they are designated to serve.

• Enrollment Portal: applications are processed through the eMedNY provider portal (https://www.emedny.org)
• Category of Service (COS) 0268: the specific MMIS enrollment category required for non-licensed HCBS providers
• NPI Requirement: agencies must possess an active National Provider Identifier (NPI) registered to their organizational entity
• Application Fee: subject to the standard federal Medicaid institutional provider application fee unless waived by existing Medicare enrollment
• Disclosure of Ownership: applicants must complete comprehensive disclosures of all managing employees and individuals with 5% or more ownership

6. Staffing, Training and Background Checks

Staff providing tenancy supports must meet specific educational and experiential thresholds set by the waiver appendices. New York places a heavy emphasis on person-centered planning credentials.

All direct-care staff must clear rigorous state and federal background checks before interacting with vulnerable Medicaid populations.

• Staff Qualifications: typically requires a high school diploma with relevant human services experience, though specific BH HCBS may require a bachelor's degree
• Person-Centered Training: staff must complete state-approved person-centered planning modules (historically developed via the Sydney Albert Training and Research Institute)
• Justice Center CBC: all staff must undergo criminal background checks through the NYS Justice Center for the Protection of People with Special Needs
• Statewide Central Register (SCR): staff must be cleared through the OCFS child abuse and maltreatment register if serving populations under 21
• Mandated Reporter Training: required certification for all staff identifying them as mandated reporters of abuse and neglect

7. Documentation, Policies and Records

The Interagency Designation Team requires a comprehensive suite of operational policies during the application phase. These documents must clearly define how the agency will execute housing supports.

Ongoing record-keeping must align with Medicaid standards, ensuring every billed unit is backed by a person-centered service plan.

• Service Descriptions: applications must include highly detailed, agency-specific descriptions of how housing search and retention will be conducted
• Person-Centered Service Plan (PCSP): all tenancy supports must be explicitly documented and authorized in the participant's overarching care plan
• Progress Notes: providers must maintain daily or per-encounter notes detailing the specific housing-related interventions provided and the participant's response
• Conflict of Interest Policy: documentation proving the agency separates case management/assessment functions from direct service delivery
• Incident Management: policies detailing the reporting of critical incidents to the DOH, OMH, and the Justice Center

8. Billing, Rates and Claims

Reimbursement for housing supports depends on the specific waiver or managed care authority authorizing the service. CTS is typically billed as a milestone or hourly service, whereas BH HCBS may use specific 15-minute increments.

Providers must navigate both fee-for-service eMedNY billing for certain waivers and managed care clearinghouses for HARP enrollees.

• Billing System: fee-for-service claims are submitted via eMedNY using the 837I or 837P electronic formats
• Managed Care Claims: BH HCBS claims must be submitted directly to the participant's HARP or Managed Care Organization
• Prior Authorization: all housing support services require prior authorization from the waiver Service Coordinator or the managed care plan
• Procedure Codes: specific HCPCS codes (such as H0043 for supported housing/environmental modifications or T2038 for community transition) dictate billing
• Rate Setting: rates are established by the DOH and published in the HCBS Provider Manual rate schedules, varying by region (Upstate vs. Downstate)

9. Approval Sequence and Timeline

Becoming a fully authorized provider is a multi-step process that spans several months. Agencies cannot rush the sequence, as eMedNY will reject applications lacking preliminary designation.

The timeline is heavily dependent on the completeness of the initial submission to the Interagency Designation Team.

• Step 1: submit the comprehensive designation application and letters of support to the NYS Interagency Designation Team
• Step 2: receive the Preliminary Designation Letter (typically 60-90 days if the application is complete and unique)
• Step 3: submit the Medicaid provider enrollment application to eMedNY under COS 0268
• Step 4: eMedNY processing and issuance of an active MMIS ID (typically 45-60 days)
• Step 5: submit the active MMIS ID to the Designation Team to receive the Formal Designation Letter
• Step 6: initiate contracting and credentialing with Medicaid Managed Care Organizations (HARPs) for behavioral health populations

10. Common Denials and Survey Findings

The state frequently returns or denies designation applications during the initial review phase due to poor documentation quality. The Interagency Designation Team explicitly warns against using generic materials.

Post-enrollment, providers face recoupments if their billing documentation does not match the authorized person-centered service plan.

• Consultant Boilerplate: applications are routinely denied if policies are copied from templates and lack agency-specific operational details
• Lack of Clarity: submissions returned due to missing timeframes, vague service definitions, or inconsistent program descriptions
• Experience Deficit: immediate rejection for agencies failing to prove the mandatory five-year operating history
• Missing Support Letters: applications from non-contracted entities denied for failing to provide the required two letters of community support
• Documentation Gaps: audit findings frequently cite missing progress notes or services delivered prior to the formal authorization date

11. Key Contacts and Resources

Providers must utilize official state portals and directories to maintain compliance and access current billing manuals. The landscape of HCBS in New York requires constant monitoring of DOH and OMH updates.

The following links provide direct access to the regulatory bodies and enrollment systems necessary for housing support providers.

• eMedNY Provider Enrollment: official portal for MMIS applications and billing guidelines (https://www.emedny.org)
• NYS DOH CTS Provider Directory: listing of currently approved Community Transitional Services providers (https://www.health.ny.gov/health_care/medicaid/redesign/directories/cts_providers.htm)
• NYS OMH Behavioral Health HCBS: resources and manuals for adult behavioral health housing supports (https://omh.ny.gov/omhweb/bho/hcbs.html)
• NYS HCBS Designation FAQs: official guidance on the non-licensed provider designation process (https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/hcbs_faqs.htm)
• Justice Center for the Protection of People with Special Needs: portal for required staff background checks (https://www.justicecenter.ny.gov)

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