OPWDD | Imamother

amother

Lilac ↓

Mon, Jun 24 2024, 4:01 pm

HCBS is a program funded by the federal government that provides services and supports to keep people with disabilities or other needs in their home (H) and Community (C).

HCBS means home and community-based services.

HCBS is an add on to medicaid, that means that in order to get HCBS services the child needs to get medicaid first. Medicaid pays for the health insurance, while HCBS/ also known as “waiver” pays for the extra services such as respite.

Medicaid is available to the child with disabilities or health needs even if the family is above income limits.

HCBS is available in every state, but this conversation is specifically about the HCBS programs available in NY. “HCBS” and “waiver” are used interchangeably in this document.

There are many different kinds of HCBS services available in NY.

The 2 most commonly used ones are:

1. OPWDD

2. Childrens’ Waiver (people call this one “HCBS” but really they are both are forms of HCBS)

3.

OPWDD is the waiver program that is meant to help people with cognitive or developmental disabilities live in their home and community.

Some things about OPWDD:

· Mostly starts at age 3

· In Long Island harder to get at age 3

· Child needs to have a diagnosis of a developmental disability or other qualifying diagnosis

· Developmental disability means:

o IQ under 70

o AND adaptive scores under 70

o OR a qualifying diagnosis that allows an IQ over 70

o Qualifying diagnoses include autism, familial dysautonomia, and others

o Disability started before the age of 21 years

· Full approval process takes on average 6-12 months, although recent laws passed should be making that shorter

· Provides services such as respite, community habilitation

· All services are geared to the person with disabilities’ needs

· Hourly rates are somewhat over minimum wage

· Workers need to have working papers (HS age okay)

· Parents apply once at age 3, re- request eligibility at age 8, and then are considered disabled

for the duration of their needs (no reauthorization after age 8)

· Services can be used flexibly to support the person with disabilities through a program called self direction

· Services can be used for camp

· Services can transfer from agency to agency

· Service such as respite can be split between multiple agencies

· Program around for decades, well built and systemized

· Meant to be a long-term program to support a person with disabilities needs throughout the lifetime

·

Some things about the Childrens’ Waiver:

· Starts at any age

· Child needs to have qualifying diagnoses of either:

· Serious emotional disturbance (i.e.ODD, OCD, eating disorders)

o Medically fragile children (2 chronic health conditions)

o Developmental Disability and Medically Fragile

o Developmental Disability and Foster Care

· Easier enrollment process (3-6 months)

· Provides services such as respite, community habilitation, and caregiver family support

· Parents can receive services such as caregiver family support

· Higher rates of pay for workers

· Workers need to have a BA

· Each service can only be received from one agency at a time, for example, respite can only be with one agency

· Need to be reauthorized every year

· New program (only open for around 5 years)

· Services may be able to be used for camp (not set in stone yet)

· Gives more hours to begin with, but without flexibility of use such as self direction

· Meant to be a 1-2 year program (not long term) to give a child and family skills to stay out of the hospital

· Based on the information gathered and what was told to me (not my conclusions), HCBS is a good option for those with medical and emotional issues and OPWDD is good for those with cognitive issues, though cases are still individualized, and depending on what you need, both options should be explored... But the above mentioned is a good rule to go by.

These days, HCBS is very helpful (for the right, eligible party) because:

-You get services while in the enrollment process

-Much quicker than OPWDD approval

-Much easier than ODWDD

-Easier billing process

-Better pay rate for providers

-Lots of different types of services are available

-There are services available for the caregiver vs OPWDD thats strictly for the child

-As a side point.... while HCBS approves services for the child with medical needs, they do not provide medical services and that comes from medicaid

However: (still based on what was told to me)

-Self direction (through OPWDD) is still usually more beneficial for the classic child (lol that doesnt exist) with developmental disabilities than HCBS (comhab, shabbatons, etc.)

-You need to reauthorize every year and at 21 it stops

-Child needs to really have significant issues to qualify for a diagnosis of “serious emotional disturbance” with a label that stays with them

-Parent is a lot more in control of the money spending in OPWDD vs HCBS

-For parents who rely on the 2 month summer break to survive all year, OPWDD is the way to go in terms of camp funding and can be the big make it or break it

amother

Saddlebrown

Mon, Jun 24 2024, 6:59 pm

amother Lilac wrote:

I don’t know where you copied and pasted this from, but OP don’t even bother with hcbs. It’s extremely difficult to get approved. Call hamaspik and start the opwdd process, you will be able to get a lot of services for your child

Just One

Mon, Jun 24 2024, 7:18 pm

amother Lilac wrote:

This is a really thought out and informative post. Thanks for this info!