Medicaid and OPWDD Services

Most OPWDD services are provided through New York State’s Medicaid program, jointly funded by the federal and state governments. OPWDD also offers limited services with state funding.

OPWDD’s largest Medicaid program is the Home and Community Based Services (HCBS) waiver.

To access services and supports from OPWDD, you will need to apply for available benefit programs (like Medicaid) that help pay for the services you need.

For example, if you are seeking HCBS waiver services, you will need to apply for, be eligible for, and enroll in Medicaid and the HCBS waiver so that the government will pay for these services. You may also pay for the cost of services with your own funds instead of enrolling in a benefit program.

Medicaid pays for the following OPWDD supports and services:

• Home and Community-Based Services (HCBS) waiver services (i.e., most OPWDD services, such as respite, supported employment, community habilitation, day habilitation, and residential services);
• Children's waiver services (for children up to age 18 who have severe medical needs and a developmental disability);
• Care coordination;
• Residential care; and,
• Additional health-related items and services (like Article 16 clinic services).

Most OPWDD services are funded through Medicaid. Therefore, in most cases, it is necessary that individuals seeking services from OPWDD enroll in Medicaid.

You must be eligible for and enrolled in Medicaid to enroll in the HCBS waiver, the Children's waiver, or Care Coordination programs. 

If you are not already enrolled in Medicaid, you can apply in a variety of ways.

When you come to OPWDD’s Front Door, Front Door staff will explain to you about the Medicaid application process, and will either give you information about the Care Coordination Organizations you can choose to help you or will link you with an Family Support Services agency to help you gather the materials you need and apply for Medicaid. 

You can also apply directly to Medicaid. To apply, you will need your personal records, for example, your birth certificate; proof of where you live, such as a rent receipt or utility bill; proof of income, such as a Social Security check; and proof of your resources, such as bank records.  You will need proof of disability and can use many of the same documents used to prove your OPWDD eligibility. You can apply directly to the Medicaid office in your county.

You can request an application for Medicaid by phone, by mail or in person through your local department of social services or by contacting a Facilitated Enroller. A Facilitated Enroller is a community agency trained to assist with Medicaid applications. A Facilitated Enroller may have hours or a location that is more convenient than the local Department of Social Services. They are available to provide application assistance but you do not have to use a Facilitated Enroller to apply for Medicaid.

If you currently work with a community services agency, staff at that agency may be able to help you with the Medicaid application process. The agency can help you complete the Medicaid application and explain what documents will be needed. 

The Medicaid Program has special provisions for people with developmental disabilities:

• People can work and still qualify for Medicaid (although depending upon their income, a person may need to contribute to service costs)
• Parental income and resources may be waived (not be considered) for children living at home and seeking enrollment in the HCBS or Care at Home waiver programs
• Financial resources can be put into a Medicaid qualifying supplemental needs trust and be exempt for Medicaid purposes