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?
Families with young children often find Waiver access challenging. While OPWDD does not officially deny based on age, in practice children under 8 are usually encouraged to first explore all available Family Support Services (FSS) before Waiver services are considered.
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 still eligible for valuable supports.
What Is FSS?
Family Support Services (FSS) are programs funded by OPWDD to help families care for their loved one with a developmental disability at home. These supports are available outside the Waiver system and can be especially helpful for younger children who are not yet approved for the Waiver.
To qualify, your child must already be found eligible for OPWDD services and live at home full-time with a parent, family member, or other unpaid caregiver. Medicaid is not required to receive FSS.
FSS programs vary by region, but may include:
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 can feel discouraging — but it’s not the end of the road. For many young children, OPWDD expects families to first use Family Support Services (FSS) before moving into Waiver-funded options like Self-Direction.
The good news is that FSS and Care Management can still provide meaningful help while you wait to reapply. With respite, recreation, after-school programs, parent training, and more, your child can continue building skills and enjoying new experiences — and you can get the support you need as a caregiver.
Many families find that, once their child is a little older and has already engaged with FSS, their Waiver application has a much higher chance of approval. Until then, you are not alone — there are supports available today to help your family 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?
Families with young children often find Waiver access challenging. While OPWDD does not officially deny based on age, in practice children under 8 are usually encouraged to first explore all available Family Support Services (FSS) before Waiver services are considered.
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 still eligible for valuable supports.
What Is FSS?
Family Support Services (FSS) are programs funded by OPWDD to help families care for their loved one with a developmental disability at home. These supports are available outside the Waiver system and can be especially helpful for younger children who are not yet approved for the Waiver.
To qualify, your child must already be found eligible for OPWDD services and live at home full-time with a parent, family member, or other unpaid caregiver. Medicaid is not required to receive FSS.
FSS programs vary by region, but may include:
- Respite (in-home or center-based)
- After-school and weekend programs
- Recreation and summer camp opportunities
- Social skills training groups
- Parent and sibling support groups
- Family reimbursement (for certain goods or services)
- Behavioral support and family counseling
- Crisis services when families need urgent help
- Specialized equipment and home modifications
- Transportation assistance
- Advocacy and service navigation
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 can feel discouraging — but it’s not the end of the road. For many young children, OPWDD expects families to first use Family Support Services (FSS) before moving into Waiver-funded options like Self-Direction.
The good news is that FSS and Care Management can still provide meaningful help while you wait to reapply. With respite, recreation, after-school programs, parent training, and more, your child can continue building skills and enjoying new experiences — and you can get the support you need as a caregiver.
Many families find that, once their child is a little older and has already engaged with FSS, their Waiver application has a much higher chance of approval. Until then, you are not alone — there are supports available today to help your family thrive.
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