The New York State Office for People With Developmental Disabilities (OPWDD) is responsible for coordinating services for more than 130,000 New Yorkers with developmental disabilities, including intellectual disabilities, cerebral palsy, Down syndrome, autism spectrum disorders, and other neurological impairments. It provides services directly and through a network of approximately 700 nonprofit service providing agencies, with about 80 percent of services provided by the private nonprofits and 20 percent provided by state-run services. 

Front Door Training Information

Eligibility for OPWDD Services

CHANGES in the application process are ongoing. Please note you will continue to have my support if you choose so, to get you through the application process. EARLY APPLICATION IS KEY!

For eligibility for OPWDD supports or services, the developmental disabilities that are defined as 'qualifying conditions' include: intellectual disability (known as "mental retardation" in Mental Hygiene Law), autism, cerebral palsy, epilepsy, familial dysautonomia, and neurological impairment (injury, malformation, or disease involving the Central Nervous System).

A lot will depend on the diagnosis.  With every single diagnosis, they always need an assessment of adaptive functioning.  They accept a Vineland or an ABAS.  In rare cases if an individual is severely intellectually disabled, they can accept a narrative describing adaptive functioning.  A good rule of thumb though is that they will almost always require a standard assessment such as the Vineland or ABAS.

Intellectual Disability: In addition to assessment of adaptive functioning mentioned above, they will also need an acceptable IQ test (Wechsler, Kaufman, Leiter, Stanford-Binet) and they cannot accept an abbreviated test.  Scores should be 60 or below.

Cerebral Palsy / Epilepsy /TBI / other neurological impairment: In addition to assessment of adaptive functioning mentioned above, they will also require an IQ test as well as medical documentation from an MD discussing what the condition is, when it began, what are the symptoms, how it impacts functioning, etc.

Autism: In addition to assessment of adaptive functioning mentioned above, they require an autism specialty report.  This should be a person-specific and detailed report of the developmental history of the autistic symptoms, course over the person’s life, and current presence, extent, and severity of autism symptoms (namely communication and social difficulties, restricted interests or repetitive behaviors) both a structured assessment via an interview of family members, a review of educational, psychological, psychiatric, medical, and with such structured scales as the CARS, ADOS, ADI-R, etc.  The ADOS and the ADI-R are the preferred measures of assessment.  They will not accept just a CARS assessment, but it can be a part of the report.  This type of report is beyond the scope of practice of the school psychologists and therefore they can refer families to outside clinics and practitioners.  See list below.

*** If the individual has any co-morbid diagnoses (ADHD, Bi-Polar, ODD, etc.)  They will need some information on how that specific diagnosis impacts his/her functioning.  They need to be able to tease out whether or not and which specific difficulties are attributable to the developmental disability and which are attributable to other disabilities.  A general reminder that ADHD and other emotional, behavioral, or psychiatric conditions would not qualify under OPWDD.  This is why they are very specific with the autism assessments, they see a lot of cases of co-morbid difficulties and psychiatric/behavioral issues that may mimic and look like autism.  Before determining a person to be eligible, they have to be sure that they truly have autism and that the autism is what’s significantly impacting their adaptive functioning.

Application Process

Information to Assist with Applying for OPWDD Eligibility

Office of Persons With Developmental Disabilities (OPWDD) Eligibility Information

-          Families can contact the district Transition Coordinator, obtain the transmittal form and the required evaluations that will be needed to determine eligibility. 

-          You will  also contact one of the three Care Coordination Organizations (CCO) for support in your application. The Care Coordinator assigned to you will walk you through the eligibility process after the intake form and evaluations are submitted. 

https://acany.org/                         https://caredesignny.org/                          https://www.tricountycare.org/  

You will need to obtain the following documentation to provide your assigned care coordinator or you can put your care coordinator in touch with your district's transition coordinator .  Please see additional eligibility information for specific diagnoses.

School District Typically Provides

-          Most Recent Re-Evaluation Testing (Cognitive and Academic) MUST BE WITHIN 3 YEARS

-          Social History (signed by Social Worker or School Psychologist) UPDATED ANNUALLY

-          Adapted Daily Living Skills Report (Vineland or ABAS)

-          Most Recent IEP 

-          Optional:

o   statements for from behavior consultant or other staff to support eligibility

o   Any additional reports or testing that has been completed and may support the needs for services

Applicant Provides

-          OPWDD Transmittal Form (must include social security #)

-          Medical Diagnosis of a Developmental Disability

-          Any outside reports that you feel are applicable

-          Copy of most recent physical (within one year of application)

-          For Autism Diagnosis – Autism Specialty Report – (ADOS or ADI-R – see additional paper for possible providers)

Once all this information is put together it is submitted to OPWDD for Eligibility Determination.

While waiting for a response from OPWDD you can complete the following –

-          Attend a Front Door Information Session or a Self-Direction Information Session – if you plan to use Self-Direction services you MUST attend a Self-Direction Information Session as of 2020.  You may attend both the Front Door and the Self –Direction sessions.

-          Make contact with a Care Coordination Organization (CCO)if you have not already

Eligibility Determination can take 6 months to over a year.  When you hear back from OPWDD you will either be made eligible or they will ask for additional information.  Reach out to your district or CCO contact if additional information is needed.

If you are made eligible you will be asked to contact the Front Door to work with a facilitator who will conduct assessments to assist in determining services.  See attached list of OPWDD services.  There is also information on the OPWDD website.

Applying for HCBS Waiver Services (Under 18 years old)

Upon receipt of the OPWDD eligibility letter, if a family is eligible for FSS Grant, their child is under the age of 18 and they feel that they need more support than was initially approved they will need to obtain HCBS waiver services.

1.   The Family should contact a CCO and request to work with a Non-Medicaid service coordinator (which is a FSS Grant service) to assist them in submitting packet for parental deeming letter.  Several weeks later the family will receive a letter that states ““Dear…

The attached letter identifies “____” as a potential OPWDD Home and Community Based Services Waiver participant and requests that the Department of Social Services disregard parental income and assets in making a Medicaid eligibility determination” Please include a copy of this letter with the Medicaid Application and supporting documentation” Applications are taken via mail or on a walk-in basis.  Please apply as soon as possible at Suffolk County DSS, 200 Wireless Blvd, Hauppauge NY 11788”.

2.   The Non Medicaid Service Coordinator then helps the family submit a Medicaid application that is attached to the parental deeming letter. Several weeks to 3 months later, they receive notification from Medicaid.

3.   Once the Medicaid card arrives, the family reaches back out to the CCO and completes an intake and enrollment application for care coordination services with that CCO.

4.   A Care Manager is assigned to the child and will submit the HCBS Waiver packet with ALL supporting documentation again (psych, social developmental, medical, consent forms, DDP-2- Level of Care, IEP, etc..) to the waiver unit at Long Island Developmental Disabilities Office (LIDDRO). **The paperwork must be within three years and a social history within a year.

5.    The Waiver Unit reviews and enrolls the child into HCBS waiver. A Notice of Decision Letter is sent to the family.

6.   With the Notice of Decision Letter (NOD) the family can then work with a Broker and begin the self-direction process which includes working with a Fiscal Intermediary, creating a budget, getting budget approval, circle of support, person centered plan, and launching.