ENROLLMENT
ENROLLMENT
Preparing for Enrollment
If you or someone you love are diagnosed with an intellectual or developmental disability and need support, here is some good information to help you get started.
In New York State, services for individuals with intellectual or developmental disabilities are provided through the Office for People with Developmental Disabilities (OPWDD), in Partnership with the Department of Health (DOH). Some of these services are paid for through the Home and Community Based Waiver, with Medicaid funds. Other services are available as well
Approval processes required: Eligibility, Waiver, Medicaid CCO, FSS, etc.
To learn more, or begin the application process, contact a Care Coordination Organization (CCO) in your area. Most CCOs employ enrollment professionals who will guide you through the entire process.
Frequently Asked Questions
What do I need in order to enroll into a CCO?
OPWDD Eligibility, Medicaid, and you must meet the level of need per the Level of Care Eligibility Determination (LCED). The Office of People with Developmental Disabilities makes decisions about OPWDD Eligibility and the LCED (in collaboration with your doctor). The federal government makes decisions about who qualifies for Medicaid.
Is OPWDD Eligibility different from the authorization of Home and Community Based Waiver services (HCBS Waiver)?
Yes. OPWDD Eligibility happens first. You must have OPWDD Eligibility to qualify for HCBS Waiver services. OPWDD makes decisions about who qualifies for Home and Community Based Services. HCBS Waiver services is a separate authorization process from OPWDD Eligibility.
- Documents required for enrollment section
- Current Psych Evaluations
- Educational Reports, Individualized Education Plans
- Report cards are not needed
- Social history
What happens once I am eligible for Care Management services?
Care Coordination Organizations (CCOs) and their Care Managers/Care Coordinators help you develop a plan for your supports and services based on your desires and needs.
What does a Care Manager/Care Coordinator do?
The Care Manager/Care Coordinator works with people eligible for OPWDD Care Management services to coordinate help across systems, to identify proper supports and community resources, and to develop a plan, called the Life Plan. The Care Manager/Care Coordinator also works with you and your Circle of Support to put the best plan in place.
What is the Circle of Support?
The Circle of Support is you, your Care Manager/Care Coordinator, and those people most involved in your life who can help you make informed decisions about what you need and want in your life. You choose who is in your circle of support.
What is the Life Plan?
The Life Plan is a personalized plan that reflects your wants and needs. It is created with you by the Care Manager/Care Coordinator and includes coordination of your supports and services needed to help you meet your goals.
What documents are required for Enrollment?
- Psychological Evaluations including IQ and adaptive scores.
- Educational Reports IEPs, report cards, OT/PT/Speech evaluations, etc.
- Social/Developmental History (if available) can be a psychosocial or other report or narrative, signed by a social worker or other clinical professional showing that a person became disabled before age 22.
- Physical completed within the last 12 months that includes a diagnosis of a developmental disability.
- Relevant medical records including any specialty assessments and documentation of a developmental disability.
- Psychiatric reports if there is a co-occurring mental health diagnosis or involvement with the county mental health clinic/counselor.
- Supporting documentation such as a developmental pediatrician report, autism evaluation, ABA therapy reports, early intervention assessments, behavior support plans, or any other documents showing evidence of an eligible diagnosis.
Required documents may vary by person and the CCO can help you obtain these documents. Please contact an Enrollment Professional for additional help or support.