OPWDD Questions

OPWDD stands for the Office for People With Developmental Disabilities. It is a New York State agency responsible for coordinating services for individuals with developmental disabilities, including intellectual disability, cerebral palsy, epilepsy, autism, neurological impairment, familial dysautonomia, and Prader-Willi Syndrome. OPWDD provides services directly and through a network of not-for-profit provider agencies across the state.

The Front Door is OPWDD's process for accessing services. It uses a person-centered approach to guide you through finding out if you are eligible for OPWDD services, identifying your needs, and developing a plan to receive supports. The goal is to provide services that respect each person's abilities, language, and cultural values.

To get started, you can visit the OPWDD website at opwdd.ny.gov/get-started and watch the Front Door videos, which explain the supports and services available, the choices OPWDD offers, and how the process works. You can also call OPWDD's Information Line at 1-866-946-9733 or contact your local Developmental Disabilities Regional Office (DDRO) directly.

OPWDD operates through five Developmental Disabilities Regional Offices (DDROs) that coordinate not-for-profit provider services and manage the Front Door process. Most of your interaction with OPWDD will be through your local DDRO. OPWDD also works with Care Coordination Organizations (CCOs) to help people develop and maintain service plans.

The eligibility determination is the review process OPWDD uses to decide whether a person has a developmental disability that qualifies them for OPWDD services and supports. Each person who wants OPWDD services has the right to an individual eligibility review.

Care Coordination Organizations or Service Access Agencies can help you and your family apply for OPWDD services. They will submit your materials and records to your local DDRO on your behalf. OPWDD does not accept documents submitted directly by individuals or families — you must work through an authorized organization.

Under New York State Mental Hygiene Law, a person must meet four requirements: (1) the presence of a developmental disability described by qualifying diagnoses or conditions, (2) the disability occurred before age 22, (3) the disability is expected to continue indefinitely or permanently, and (4) the disability causes a substantial handicap to the person's ability to function normally in society.

Developmental disabilities are conditions that occur before age 22 and continue throughout a person's life. Qualifying conditions include, but are not limited to, intellectual disability, autism, cerebral palsy, epilepsy, familial dysautonomia, Prader-Willi Syndrome, and neurological impairment (injury, malformation, or disease involving the central nervous system). These are different from developmental delays, which may improve with early intervention.

Mental illness on its own (such as bipolar disorder or depression), loss or absence of senses, motor skills, or physical abilities, and mild forms of conditions like cerebral palsy, seizure disorder, or brain injury — if there is no evidence of substantial handicap — do not qualify. However, a person may still be eligible if they have one of these conditions alongside a qualifying developmental disability.

For OPWDD eligibility, "substantial handicap" means that a person's developmental disability is so serious that it makes it very difficult for them to live everyday life independently. Qualified professionals are trained to evaluate individuals for developmental disabilities and assess difficulties with everyday functioning.

Generally, the following records are needed: a psychological report (within three years) that includes an IQ assessment, a standardized evaluation of adaptive behavior, a social or developmental history showing the disability existed before age 22, a recent general medical report (within the past year), and, for conditions other than intellectual disability, medical or specialty reports that confirm the diagnosis. Educational records such as IEPs and report cards can also be helpful.

For children between birth and eight years of age, the eligibility review requirements are generally the same as for adults, with some flexibility. In some cases, children may receive provisional eligibility, which grants OPWDD services for a limited period of time. All children with provisional eligibility must be reviewed again before their eighth birthday to determine if they remain eligible.

No. There is no age limit for requesting an eligibility review. Eligibility can be reviewed from infancy through adulthood. However, as a person gets older, it may become more difficult to find the records needed to prove the disability was present before age 22.

The process has three review steps to ensure fairness. In the First Step, DDRO staff review your request to confirm it is complete. In the Second Step, a committee of clinicians evaluates your materials. If you are found ineligible, you can meet with staff, request a Third Step Review by an independent committee, and request a Medicaid Fair Hearing if you are seeking Medicaid-funded services.

Most OPWDD services are funded through New York State's Medicaid program. You must be eligible for and enrolled in Medicaid to access most OPWDD services, including the Home and Community-Based Services (HCBS) waiver and Care Coordination programs. Individuals may also choose to pay for services with their own funds instead of enrolling in Medicaid.

There are several ways to apply: you can apply directly through your county's Medicaid office, apply through New York State of Health by calling 1-855-355-5777, work with a community services agency for help, or be referred by OPWDD's Front Door to a Care Coordination Organization that will assist you. You can also call 1-800-541-2831 for help completing the application.

Individuals with disabilities age 18 or older are generally eligible if their income and resources are below certain limits. Programs like the Medicaid Buy-In for Working People with Disabilities allow working adults to keep more of their income. Children under 18 with developmental disabilities may qualify based on their own or their family's income. In some cases, parental income is not considered when a child applies for the OPWDD HCBS waiver.

The Home and Community-Based Services (HCBS) waiver is OPWDD's largest Medicaid program. It offers services to support individuals living in the community so they do not need to live in institutions. To enroll, you must fill out an Application for Participation and provide evidence of a developmental disability, an appropriate level of need, Medicaid eligibility, and an appropriate living arrangement.

If your Medicaid application is denied, you will receive a letter explaining the decision. You should save this letter and share it with your Care Coordination Organization or Family Support Services agency, who can help you determine whether to appeal the decision and guide you through the appeals process.

Once you are eligible, OPWDD will assess your needs, strengths, and abilities using tools like the Developmental Disabilities Profile (DDP-2) and the Coordinated Assessment System (CAS). A Care Manager will then work with you and your family to make informed decisions about services and develop a personalized Life Plan.

A Care Manager is a professional who works for a Care Coordination Organization (CCO). They help you coordinate healthcare, wellness, and developmental disability services. Your Care Manager develops your Life Plan, helps you make informed choices, connects you with community resources, and ensures your services are delivered as planned. You choose which CCO you want to work with from the options in your region.

Your Circle of Support is a group of people you choose to help you plan your services and make decisions. It can include family members, friends, your Care Manager, and other people important to you. The circle can be as small as you and your Care Manager, or as large as you like. Members meet regularly to develop your service plan, evaluate its success, and make adjustments as needed.

A Life Plan is your individualized service plan, developed by your Care Manager working with you and your Circle of Support. It is a roadmap to your personal goals and describes the supports and services that will help you get there. Your Care Manager documents what services you need, how you will access them, and continually reviews the plan to make sure it is meeting your needs.

Person-centered planning is the approach OPWDD uses to make sure services are designed around you. It focuses on what is important to you, how you want to live, and what your abilities, interests, and goals are. You and the people important to you direct the planning process, and your Care Manager helps explore how OPWDD can provide the support you need.

Self-Direction is a service model that gives you and your family the power to choose your own supports, hire your own staff, and manage a personalized budget. Services are paid from your Personal Resource Account (PRA), a budget amount based on your assessed needs. You can choose to self-direct some or all of your services, giving you maximum flexibility and control.

Employer Authority allows you to be responsible for hiring the staff who provide your supports and services. You co-manage staff with a provider agency that can help with recruiting, supervising, and directing support workers, or you can handle some or all of those responsibilities yourself. The provider agency also helps with employee screening and payroll.

Budget Authority allows you to manage your individualized Self-Direction budget. You make decisions about which supports and services are included in your Life Plan, who is paid to provide them, how they are purchased, and how much your self-hired staff are paid. A Fiscal Intermediary helps you by handling billing, payments, accounting, and reporting.

A Fiscal Intermediary (FI) is an agency that helps manage the financial side of your self-directed services. They handle payroll for your staff, process billing and payments for approved services, ensure compliance with state regulations, and provide fiscal accounting and reporting on your behalf.

A Support Broker is a trained professional who helps individuals and families navigate the self-directed services system. They assist with understanding your options, developing your budget, hiring staff, coordinating services, and ensuring that your personal goals and needs are met throughout the Self-Direction process.

OPWDD provides a wide range of services, including: help living independently with rent subsidies and community habilitation; family support services such as respite; employment training, job coaching, and supported employment; day habilitation programs; residential supports for individuals with higher needs; assistive technology and environmental modifications; and behavioral health and crisis services.

OPWDD offers several housing options. The Housing Subsidy helps adults pay for rent and utilities in their own apartment. Family Care provides housing in private homes certified by OPWDD. Individualized Residential Alternatives (IRAs), also known as group homes, provide room, board, and individualized supports in a home-like setting. The right option depends on each person's level of need and personal goals.

OPWDD offers several employment-related services. Pathway to Employment helps you develop a career plan. Community Prevocational Services teach work-related skills. Supported Employment (SEMP) helps you find and keep a competitive job in the community with ongoing job coaching. The Employment Training Program (ETP) offers paid internships with enhanced coaching and job readiness classes.

Family Support Services help families who care for a loved one with a developmental disability at home. These services include respite care, family member training, support groups, training in managing challenging behaviors, parent-to-parent networking, sibling services, after-school programs, and recreational and social activities.

Respite services provide temporary relief to family members and caregivers who are responsible for the primary care of a person with a developmental disability. Respite can be provided in-home, at a camp, through recreational programs, or at a designated site, and is available even for individuals with more serious health or behavioral needs.

Schools provide special education services until a student graduates or completes their program at the end of the school year in which they turn 21. Schools are expected to begin planning the transition to adult services before the student turns 15. OPWDD's Front Door staff and Care Managers work with local schools to plan the supports students may need as adults. Families are encouraged to start the eligibility and planning process as early as possible to avoid any gaps in service.

You can call OPWDD's toll-free Information Line at 1-866-946-9733 for questions about services, eligibility, or concerns. You can also visit the OPWDD website at www.opwdd.ny.gov, email info@opwdd.ny.gov, or visit their Facebook page. If you speak a language other than English, representatives can assist you or connect you with an interpreter. Individuals with hearing impairment can use the NY Relay System at 7-1-1.