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Medicaid and OPWDD Services

02/27/12

The Medicaid program is administered by the New York State Department of Health through the local Departments of Social Services (LDSS) or for most individuals who live in state-operated residential programs and certain individuals in certain voluntary agency residential programs, Medicaid is administered by OPWDD as Medicaid District 98 through the Revenue Support Field Offices (RSFOs).

Medicaid is a special needs-based health insurance program that pays for:

  • Home and Community-Based Services (HCBS) Waiver
  • Care at Home Waiver
  • Medicaid Service Coordination
  • Residential Care in Developmental Centers and Intermediate Care Facilities
  • Additional health-related items and services

The Medicaid Program has special provisions for people with developmental disabilities:

  • Individuals can work and still qualify for Medicaid
  • Parental income and resources are not considered for children living at home and seeking enrollment in the HCBSWaiver.
  • Resources can be put into a Medicaid qualifying supplemental needs trust and be exempt for Medicaid purposes. 

For information on Medicaid related to individuals receiving NYS OPWDD services, the application process, coverages, and Medicaid programs, please refer to our Benefit Development Resource Guide.

If you want Medicaid to pay for your OPWDD Services, you must request certain Medicaid coverage.  The below links may be helpful:

Liability for Services

Long Term Care Services

Explanation of the Income and Resource Documentation Requirements for Medicaid

Medicaid Coverage Chart

For additional information on the Medicaid program, please refer to the NYS Department of Health's website.

Created on Monday, 27 Feb 2012 at 1:49 pm.

Last updated on Wednesday, 5 Nov 2014 at 3:40 pm.