Disability Benefits
Applying for the HCBS Waiver Program
This guide was created to help you navigate this process efficiently and with confidence. Having your important records, evaluations, reports, medical documents, insurance information, identification, and supporting paperwork digitally scanned, organized, and readily accessible can save valuable time and reduce stress throughout this process. With iDocThis, all of your important documents are securely stored, organized, and available whenever and wherever you need them.
Many states offer a Home and Community-Based Services (HCBS) waiver program through Medicaid. These programs provide a range of supports, including respite care, community habilitation, vocational training, day habilitation programs, housing and residential supports, personal care aids, and behavioral or therapeutic services.
In addition, many states offer a Self-Direction program, which allows participants to receive a budget from the state and directly hire and manage their own support staff.
Services through the HCBS waiver can offer individuals tremendous support and growth opportunities that would likely otherwise be beyond financial reach for most families. Most families that have HCBS waiver services for their loved ones would not consider moving and giving up their services, as they dramatically improve the quality of life for their loved ones and family.
Apply as early as possible — if your state has an HCBS waiver program, it is recommended to apply early, as some states have waiting lists. Eligibility criteria vary: in many states, children can apply and parental income is not considered. In others, parental income and assets may be factored into the eligibility determination for minors. The application process differs by state but typically requires similar personal and financial information as outlined below.
In New York, individuals apply by reaching out to the Office for People with Developmental Disabilities (OPWDD) and requesting a Front Door Intake. They will collect basic information and advise you of the Care Coordination Organizations (CCO) in your area that can assist with your application for eligibility, waiver enrollment, service authorizations, and ultimately care management services.
In order to apply you will need to do the following:
Confirm the Individual Meets Basic Eligibility Requirements
- Diagnosed before age 22: The individual must be diagnosed with a developmental disability before the age of 22.
- Indefinite duration: The disability must be expected to last indefinitely.
- Substantial limitations: The disability must result in substantial limitations in functioning in three or more life areas including mobility, language, self-care, decision making/personal management, and/or learning.
Obtain a Qualifying Diagnosis
- Autism Spectrum Disorder (ASD)
- Intellectual Disability (ID)
- Cerebral Palsy
- Epilepsy
- Familial Dysautonomia
- Other neurological impairments or conditions similar to intellectual disabilities
Note: Learning disabilities or mental health disorders alone do not qualify unless accompanied by a developmental disability.
Gather Required Documentation
- Psychological evaluation: Must include a recent full-scale IQ and Adaptive Behavior Assessment.
- Social history report: Must be within 1 year and can be completed by the school district or any licensed psychologist or social worker.
- Diagnosis report: Written by a licensed psychologist, physician, or psychiatrist confirming the qualifying developmental disability. Confirmation of an autism diagnosis requires an Autism Specialty report using a CARS or ADOS-2 and DSM-V comparison to diagnose.
- Medical records: Most recent physical within 1 year, plus any recent health evaluations, neurological reports, or genetic testing (if applicable to diagnosis).
- Evidence of disability onset before age 22. Examples: early childhood developmental evaluations, school records (e.g., IEPs, psychological assessments), pediatrician or specialist reports.
- Doctor's letter: A letter from a medical doctor confirming the medical diagnosis and recommending that the patient would benefit from the Home and Community Based Services Waiver through the Office for People With Developmental Disabilities.
- Copy of the parent's driver license.
- Copy of the individual's insurance card.
Submit the documentation in one submission to the CCO for them to complete the OPWDD application.
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