Getting an OPWDD eligibility letter can feel like a major win — and it is! But many families are surprised (and frustrated) when they later find out their child has been denied the Waiver — especially if they were hoping to join the Self-Direction program.
If this happened to you, you're not alone. Let's walk through what this means, why it happens, and what support is still available to your family.
First, What's the Difference?
Why Was My Child Denied the Waiver?
Here’s the truth many families face — children under age 8 are frequently denied Waiver access, even if they meet all the formal requirements. While OPWDD might not officially say “it’s because of age,” many brokers and care managers see this pattern often.
Other common reasons for denial:
What Can You Do?
Appeal the Decision
Ask your Care Manager to request a Fair Hearing or re-review. Sometimes additional documentation (like updated evaluations) can help reverse the decision.
But if the denial still stands — don't give up. Your child may still be eligible for valuable supports.
What Is FSS?
FSS stands for Family Support Services — a set of programs offered by OPWDD outside the Waiver system. These services are designed to support families caring for a loved one with developmental disabilities at home.
Examples of FSS programs:
Ask your Care Manager what FSS programs are available in your borough or county — availability varies based on local providers.
What Can a Care Manager Do For You?
Even without the Waiver, your Care Manager remains your main guide through the OPWDD system. They can:
Final Thoughts
Being denied the Waiver isn’t the end of the road — especially for young children. Many families successfully reapply later (around age 8 or older). In the meantime, Care Management and FSS can still offer meaningful support to help your child grow and thrive.
If this happened to you, you're not alone. Let's walk through what this means, why it happens, and what support is still available to your family.
First, What's the Difference?
- OPWDD Eligibility: Confirms your child has a developmental disability and qualifies for OPWDD support.
- HCBS Waiver Eligibility: Needed to access Medicaid-funded services like Self-Direction, Respite, Community Habilitation, and Supported Employment.
Why Was My Child Denied the Waiver?
Here’s the truth many families face — children under age 8 are frequently denied Waiver access, even if they meet all the formal requirements. While OPWDD might not officially say “it’s because of age,” many brokers and care managers see this pattern often.
Other common reasons for denial:
- Lack of active Medicaid
- Not meeting Level of Care criteria
- Paperwork errors or missing evaluations
What Can You Do?
Appeal the Decision
Ask your Care Manager to request a Fair Hearing or re-review. Sometimes additional documentation (like updated evaluations) can help reverse the decision.
But if the denial still stands — don't give up. Your child may still be eligible for valuable supports.
What Is FSS?
FSS stands for Family Support Services — a set of programs offered by OPWDD outside the Waiver system. These services are designed to support families caring for a loved one with developmental disabilities at home.
Examples of FSS programs:
- Center-Based Respite Programs
- Parent training workshops
- Support groups
- Sibling support groups
- Recreation programs
- After-school and weekend programs
- Limited reimbursements for goods/services (e.g., adaptive equipment or therapeutic items)
Ask your Care Manager what FSS programs are available in your borough or county — availability varies based on local providers.
What Can a Care Manager Do For You?
Even without the Waiver, your Care Manager remains your main guide through the OPWDD system. They can:
- Help you file an appeal or Fair Hearing
- Connect you with FSS programs and other OPWDD-funded supports
- Assist with Medicaid applications or renewals
- Coordinate evaluations and updated documentation
- Refer you to appropriate community resources
- Help build a plan for reapplying to the Waiver in the future
Final Thoughts
Being denied the Waiver isn’t the end of the road — especially for young children. Many families successfully reapply later (around age 8 or older). In the meantime, Care Management and FSS can still offer meaningful support to help your child grow and thrive.
Read other articles: