If you are looking to get care coordination/care management services, there are two pathways for children under the age of 18.

Path 1 (under 18):

• A child has Medicaid as their health insurance. Medicaid is given to the child based on the parent’s income.
• Apply for OPWDD Eligibility, and if approved, an LCED is completed. At this point, a child can enroll in a CCO, and they are assigned a Care Manager/Care Coordinator.
• Care Manager/Care Coordinator helps the child apply for Waiver Services. These could be approved or denied by OPWDD.
  • If Waiver Services are denied, the child/family can access Family Support Services and Care Management without Waiver approval, as long as OPWDD eligibility and Medicaid remain active.
  • The child can apply for Waiver Services again when they exhaust FSS or are more appropriate for Waiver Services.

Path 2 (under 18):

• The child does not have Medicaid because family does not qualify based on parent’s income. The child might have Child Health Plus or a third-party insurance.
• Apply for OPWDD Eligibility, and if approved, an LCED is completed.
• If the child has been approved for OPWDD Eligibility, they cannot enroll into a CCO because they do not have Medicaid.
  • Now, the child can EITHER
    • Pursue FSS only with the support of the Member Relations team or on their own;

• • • Apply for Waiver Services with a Specialized Admissions Coordinator (SAC) on the Care Connection team

*NOTE: Both avenues can be pursued at the same time*

• If the child applied for Waiver Services, OPWDDthen reviews the request. OPWDD can either approve or deny the Waiver request.
• If approved, OPWDDprovides the SAC and the family with a letter of intent. This letter says the child is qualified for Waiver Services and the parents’ income should be waived so that Medicaid can be approved in order to fund the Waiver Services that have been authorized. Once this is received, the family works with a Benefits Coordinator to apply for Medicaid with the letter of intent. Once Medicaid is approved, the child enrolls in a CCO and is assigned a Care Manager/Care Coordinator who further coordinates Waiver Services.
• If denied, the child can continue to access FSS The child cannot have a Care Manager/Care Coordinator at this point because Waiver Services were denied, so there is no Medicaid is forthcoming. Families can appeal the denial. There are resources that can assist families with the appeal process. The child and family can then apply for Waiver Services again at a time when their situation is different, or updated information can be provided.

Other Pathways to Coordinated Care Services

There are also other pathways to Care Coordination services. Here are the other ways:

• If a person needing services is over 18, parental income doesn’t apply, and obtaining Medicaid is a more straightforward process.
• People can also transition from one Medicaid Waiver to another. Medicaid coding would need to change, and the person would need to apply for Home and Community Based  (HCBS) Waiver Services with OPWDD. Care Managers/Care Coordinators can help with this.
• If a person is 18 or over and wants to enroll in a CCO, CCO staff could help the person apply for OPWDD eligibility. Once approved, a Benefits Coordinator could help with the Medicaid application. Then, the person can enroll into the CCO, and a Care Manager/Care Coordinator can help access other services.

We understand that this is a complex process, and if you need support, please contact your Care Connection Specialist or Member Relations.