Applying for supports and services through the Office for People With Developmental Disabilities (OPWDD) can feel overwhelming for families. This guide explains the Eligibility Determination Process and what steps you need to take to get started.
Who Can Apply?
People with developmental disabilities can apply for OPWDD services. To be eligible, your child must meet all four requirements:
Step 1. Gather the Required Documentations
Adaptive Behavior Testing (such as the Vineland II or ABAS) – This is an interview or form completed by someone familiar with the person, in order to provide information about their daily living skills and functioning. As with IQ testing, the report should include all scale and summary scores and a narrative report written by the clinician. Computer generated reports alone are not acceptable.
submitted for school-aged people. Also include any psycho educational reports referenced in the plan. For those who are no longer in school (e.g., no longer school aged, they have graduated), you must submit any school records available.
Early Intervention (EI): If the person has an EI plan, they must submit it. This includes the Core
Evaluation and progress notes, including a level of deficit for each domain.
💡 If you don’t have the required evaluations, you may be able to get them at an Article 16 Clinic, which offers evaluations and therapeutic services for people with developmental disabilities.
P.S. Additional information may be requested by OPWDD as needed.
Step 2. Watch the OPWDD Front Door Information Videos
Watch the OPWDD Front Door Information Videos to learn more about the eligibility process and services offered (available in English, Spanish, and Chinese) https://opwdd.ny.gov/access-supports/front-door-videos
OPWDD will provide translation services for anyone who needs a different language. Contact language.access.requests@opwdd.ny.gov to submit a request.
Step 3. Contact A Care Coordination Agency
OPWDD works in partnership with Care Coordination Organizations (CCOs) to support individuals in developing and maintaining service plans. Once you enroll with a CCO, a Care Manager will be assigned to you. The Care Manager’s role is to:
Step 4. Complete the DDP-2 and CANS/CAS Assessments
Your Care Manager will assist you in applying and all required documents to the eligibility department at the Developmental Disabilities Regional Office (DDRO) in your borough. After the DDRO reviews your documents, they will mail you an eligibility determination letter to let you know whether your child is eligible. If you don’t receive an eligibility determination letter after month, contact your Care Manager to follow up.
After sending the eligibility determination letter that informs you whether your child is eligible for services, the DDRO will call you to schedule the Developmental Disabilities Profile (DDP-2) interview and Child and Adolescent Needs and Strengths (CANS) Assessment interview for those 17 and younger or the Coordinated Assessment System (CAS) for those ages 18 and over. These are comprehensive assessments that OPWDD uses to identify the young persons’ strengths, needs, and interests which provides information used in person-centered planning for the person’s care. You can get more information about the assessments here: https://opwdd.ny.gov/getting-started/assessments. Call to schedule and complete the assessments if you have not heard from the DDRO within two weeks of receiving the eligibility determination letter. You will need your child’s TABS ID number, which can be found on the eligibility determination letter.
Denial of Eligibility and Appeals
If OPWDD decides that your child is not eligible for services, you can appeal through what is called a 2nd Step Review. During the 2nd Step Review, you may submit additional documents and ask OPWDD to review all the documents again. If OPWDD finds your child not eligible a second time, you can complete a 3rd Step Review and request a Medicaid Fair Hearing. Be aware of the deadlines for requesting these appeals.
For more information on the steps and accepted evaluation tools: https://opwdd.ny.gov/eligibility
Eligibility for Children Under 8
The eligibility requirements for OPWDD are the same for individuals of all ages. However, children aged 8 and under may be granted provisional eligibility. This means your child can be found fully OPWDD eligible, but the eligibility is considered temporary until their 8th birthday. During this time, they may access OPWDD services — but in many cases, young children are approved for OPWDD eligibility yet denied the HCBS Medicaid Waiver, especially those under age 8.
To convert provisional eligibility into permanent standard eligibility, updated evaluations must be submitted to the DDRO before your child turns 8. It is best practice to begin this re-evaluation process around your child’s 7th birthday, and your Care Manager will assist you with scheduling updated evaluations, gathering reports, and submitting them to the DDRO.
👉 If your child was approved for OPWDD eligibility but denied the HCBS Waiver, you can read more in my article: “My Child Was Found Eligible for OPWDD — But Denied the Waiver. What Can I Do?”
Who Can Apply?
People with developmental disabilities can apply for OPWDD services. To be eligible, your child must meet all four requirements:
- Have a diagnosis of a developmental disability (intellectual disability, cerebral palsy, epilepsy, neurological impairment, autism, familial dysautonomia, Prader-Willi Syndrome, etc.).
- The disability was diagnosed before age 22.
- The disability is expected to be permanent.
- The disability seriously affects your child’s ability to live everyday life independently.
Step 1. Gather the Required Documentations
- Psychological Evaluation (less than 3 years old). It should include:
Adaptive Behavior Testing (such as the Vineland II or ABAS) – This is an interview or form completed by someone familiar with the person, in order to provide information about their daily living skills and functioning. As with IQ testing, the report should include all scale and summary scores and a narrative report written by the clinician. Computer generated reports alone are not acceptable.
- Social history/psychosocial Evaluation (less than 1 year old)
- Educational Records
submitted for school-aged people. Also include any psycho educational reports referenced in the plan. For those who are no longer in school (e.g., no longer school aged, they have graduated), you must submit any school records available.
Early Intervention (EI): If the person has an EI plan, they must submit it. This includes the Core
Evaluation and progress notes, including a level of deficit for each domain.
- Medical Report (less than 1 year old)
💡 If you don’t have the required evaluations, you may be able to get them at an Article 16 Clinic, which offers evaluations and therapeutic services for people with developmental disabilities.
P.S. Additional information may be requested by OPWDD as needed.
Step 2. Watch the OPWDD Front Door Information Videos
Watch the OPWDD Front Door Information Videos to learn more about the eligibility process and services offered (available in English, Spanish, and Chinese) https://opwdd.ny.gov/access-supports/front-door-videos
OPWDD will provide translation services for anyone who needs a different language. Contact language.access.requests@opwdd.ny.gov to submit a request.
Step 3. Contact A Care Coordination Agency
OPWDD works in partnership with Care Coordination Organizations (CCOs) to support individuals in developing and maintaining service plans. Once you enroll with a CCO, a Care Manager will be assigned to you. The Care Manager’s role is to:
- Submit all evaluations and required reports on your behalf to local DDRO to establish OPWDD eligibility.
- Guide you through the OPWDD eligibility determination process.
- Help appeal an OPWDD denial, if eligibility is not granted on the first review.
- Assist with applying for Medicaid, if your child is not already enrolled.
- Submit the application for the Home and Community-Based Services (HCBS) Waiver.
- Initiate the Self-Direction enrollment process when the child becomes eligible for HCBS Waiver.
- Coordinate ongoing assessments (DDP-2, CANS/CAS) and help build the Life Plan once eligibility is confirmed.
- Advanced Care Alliance (ACA)
- Care Design NY
- Tri-County Care (currently not accepting new participants)
Step 4. Complete the DDP-2 and CANS/CAS Assessments
Your Care Manager will assist you in applying and all required documents to the eligibility department at the Developmental Disabilities Regional Office (DDRO) in your borough. After the DDRO reviews your documents, they will mail you an eligibility determination letter to let you know whether your child is eligible. If you don’t receive an eligibility determination letter after month, contact your Care Manager to follow up.
After sending the eligibility determination letter that informs you whether your child is eligible for services, the DDRO will call you to schedule the Developmental Disabilities Profile (DDP-2) interview and Child and Adolescent Needs and Strengths (CANS) Assessment interview for those 17 and younger or the Coordinated Assessment System (CAS) for those ages 18 and over. These are comprehensive assessments that OPWDD uses to identify the young persons’ strengths, needs, and interests which provides information used in person-centered planning for the person’s care. You can get more information about the assessments here: https://opwdd.ny.gov/getting-started/assessments. Call to schedule and complete the assessments if you have not heard from the DDRO within two weeks of receiving the eligibility determination letter. You will need your child’s TABS ID number, which can be found on the eligibility determination letter.
Denial of Eligibility and Appeals
If OPWDD decides that your child is not eligible for services, you can appeal through what is called a 2nd Step Review. During the 2nd Step Review, you may submit additional documents and ask OPWDD to review all the documents again. If OPWDD finds your child not eligible a second time, you can complete a 3rd Step Review and request a Medicaid Fair Hearing. Be aware of the deadlines for requesting these appeals.
For more information on the steps and accepted evaluation tools: https://opwdd.ny.gov/eligibility
Eligibility for Children Under 8
The eligibility requirements for OPWDD are the same for individuals of all ages. However, children aged 8 and under may be granted provisional eligibility. This means your child can be found fully OPWDD eligible, but the eligibility is considered temporary until their 8th birthday. During this time, they may access OPWDD services — but in many cases, young children are approved for OPWDD eligibility yet denied the HCBS Medicaid Waiver, especially those under age 8.
To convert provisional eligibility into permanent standard eligibility, updated evaluations must be submitted to the DDRO before your child turns 8. It is best practice to begin this re-evaluation process around your child’s 7th birthday, and your Care Manager will assist you with scheduling updated evaluations, gathering reports, and submitting them to the DDRO.
👉 If your child was approved for OPWDD eligibility but denied the HCBS Waiver, you can read more in my article: “My Child Was Found Eligible for OPWDD — But Denied the Waiver. What Can I Do?”
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