NY OPWDD Comprehensive Waiver

Family caregivers are the backbone of the healthcare system, providing essential care and support to their loved ones with intellectual and developmental disabilities (IDD). However, many family caregivers face financial and emotional challenges, such as low income, high stress, and limited access to services and supports. That’s why Medicaid programs like the OPWDD Comprehensive Waiver in New York are so important. They offer family caregivers the opportunity to receive compensation and self-direction for their caregiving role and a range of services and supports for their loved ones.

Overview of OPWDD Comprehensive Waiver

The OPWDD Comprehensive Waiver is a Medicaid program that provides home and community-based services (HCBS) to individuals with IDD who meet an institutional level of care. The program is administered by the New York State Office for People With Developmental Disabilities (OPWDD) and the Department of Health (DOH), with approval from the federal Centers for Medicare and Medicaid Services (CMS).

The purpose of the OPWDD Comprehensive Waiver is to promote the health, safety, independence, and quality of life of individuals with IDD and to support their families and caregivers. The program aims to prevent or delay institutionalization, enhance community integration, increase individual choice and control, and reduce costs.

The OPWDD Comprehensive Waiver serves individuals with IDD of any age who live in New York State. As of July 2021, there were about 85,000 individuals enrolled in the program. The program is expected to undergo changes in October 2023, pending federal approval.

Eligibility requirements

To be eligible for the OPWDD Comprehensive Waiver, an individual must meet the following criteria:

• Have a diagnosis of a developmental disability that occurred before age 22 and is expected to last indefinitely.
• Be eligible for the intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care, meaning they need active treatment and 24-hour supervision due to their disability.
• Be Medicaid eligible, which means that they meet certain income and resource limits or qualify for a Medicaid buy-in program.
• Choose HCBS waiver services over institutional care.

To apply for the OPWDD Comprehensive Waiver, an individual must contact their local Developmental Disabilities Regional Office (DDRO) to request an eligibility determination. If they are found eligible, they will be assigned a care manager to help them develop a person-centered care plan and enroll them in the waiver.

Services and supports

The OPWDD Comprehensive Waiver offers various services and supports tailored to the individual’s needs, preferences, and goals. Some of these services and supports include:

• Day habilitation: Provides opportunities for skill development, socialization, recreation, and community participation in a group setting.
• Live-in caregiver: Provides room and board to an individual with a non-relative caregiver who provides care and supervision.
• Prevocational services: Provides training and support to prepare individuals for paid or volunteer work in the community.
• Residential habilitation: Assists with daily living skills, personal care, health care, and community integration in a residential setting.
• Respite: Provides temporary relief to family caregivers by offering short-term care to an individual in their home or another environment.
• Supported employment: Provides ongoing support to help individuals find and maintain paid work in the community.
• Community transition services: Provides one-time assistance to help an individual move from an institutional to a community setting.
• Fiscal intermediary: Provides financial management services to individuals who self-direct their services.
• Individual-directed goods and services: Provides goods or services that are not otherwise available under the waiver or Medicaid state plan but are necessary to meet an individual’s needs.
• Support brokerage: Provides information, guidance, and advocacy to individuals who self-direct their services.
• Assistive technology/adaptive devices: Provides equipment that enhances an individual’s functioning, independence, or safety.
• Community habilitation: Provides assistance with daily living skills, personal care, health care, and community integration in an individual’s home or community.
• Environmental modifications: Provides physical adaptations to an individual’s home or vehicle that improve accessibility, safety, or independence.
• Family education and training: Provides education and training to family members or caregivers on supporting an individual’s needs.
• Intensive behavioral services: Provides assessment, intervention, and support to individuals with challenging behaviors that interfere with their health or safety.
• Pathway to employment: Provides career planning and exploration services to help an individual identify a career goal and develop a plan to achieve it.
• Vehicle modification: Provides adaptations to an individual’s vehicle that improve accessibility, safety, or independence.

Compensation for caregivers

One of the most attractive features of the OPWDD Comprehensive Waiver is that it allows individuals to self-direct their services through employer and budget authorities. Employer authority means that individuals can hire, train, supervise, and dismiss their staff, including family members. Budget authority means individuals can manage a personal resource account to purchase goods and services that meet their needs.

Self-direction gives individuals more choice and control over their services, as well as the opportunity to compensate their family caregivers for the work that they do. Family caregivers can be paid for providing certain services under the waiver, such as community habilitation, respite, or supported employment. However, there are some limitations and restrictions on who can be paid and how much. For example, spouses and legally responsible relatives cannot be paid as caregivers. OPWDD determines the rates of pay and vary by service and region.

Individuals must work with their care manager and a fiscal intermediary to develop a self-directed budget and a circle of support to participate in self-direction. A fiscal intermediary is an agency that handles the payroll and taxes for the caregivers. A circle of support is a group of people who help the individual plan and monitor their services.

A note from Givers

If you are interested in applying for this program or finding out if you might be eligible for compensation, please fill out this form, and we will get back to you soon.