Waiver Eligibility Requirements

 General Policy Clarification: What a Family Needs To Know

To get services for your family member who has a developmental disability you must do four things:

1. You must get paperwork saying that your family member has a developmental disability.

2. You must fill out special state OPWDD forms.

3. You must apply for government benefits that pay for the services your family member needs. These benefits are: Supplemental Security Income (SSI), Medicaid, and in some cases Social Security.

4. With help from your service provider you must sign up for the "OPWDD Home and Community Based Services Waiver" if you want to receive HCBS Waiver services.

What happens if you don't apply for benefits?

If you do not apply for benefits to pay for services for your family member, you will have to pay the service provider for the services.

What happens if you apply for benefits but don't get them?

If you apply for government benefits for your family member and are turned down you must show your family member's service provider the papers from the government saying that your family member cannot get the benefit. We will discuss next steps with you.

Medicaid Service Coordinators and other Sinergia staff are available to you in order to make the Medicaid Home and Community Based Waiver (HCBS) enrollment process easier. If you would like to have someone explain the process to you, and to help you with enrollment in New York State Office for People With Developmental Disabilities programs, please feel free to call Sinergia's main office toll-free at 866-867-9665.

In order to determine whether or not a candidate is eligible to receive services provided by the New York State Office for People with Developmental Disabilities (NYS OPWDD) and the voluntary agencies that it regulates, the selected state operated or voluntary agency will need the following information from the prospective candidate.

•A medical or specialty report (for example, a neurological report) including health status and diagnostic findings to support a qualifying diagnosis other than developmental disability;
For persons qualifying with developmental disability only, a recent general medical report, if available

• A psychological report which includes assessment of intellectual functioning with reporting of intelligence scores (including subscale, part, and full scale scores), and, for people with IQs above 60, standardized assessment of adaptive behavior with reporting of scale and summary scores (for people with IQs below 60, assessment may be based on qualitative review via interview with care-providers, review of records, and direct observations)

•A social history, psychosocial report, or other background report that shows that the person became disabled before age 22 years (background information is still needed if the person is a child or adolescent)

Additionally, in order to be eligible for any and all programs, participants must be enrolled in the Home and Community Based Services Waiver (HCBS) and receive and maintain Medicaid Service Coordination (MSC) services. It is also mandated for people participating in the HCBS Waiver program that during the first three months of Waiver participation that a proper Individualized Service Plan (ISP) be developed. All members of the Willowbrook class must receive service coordination. For more information please follow this link: http://www.omr.state.ny.us/wt/forms/wt_important_facts.jsp

These programs are certified by the New York State Office for People with Developmental Disabilities (OPWDD) and funded through the Medicaid Home and Community Waiver Services.