Wellbound Knowledge Base
The OPWDD Eligibility Review – How it works?
The eligibility review process is the way OPWDD determines if you have a developmental disability and are eligible for OPWDD supports and services.
The eligibility review process begins at one of OPWDD’s five Developmental Disability Regional Offices (DDROs) located throughout New York State. You and your family submit materials and records to the DDRO, such as reports of assessments conducted by medical professionals. A Care Manager may help you with this process.
Qualified DDRO staff review this information to see if your disability meets requirements specified in New York State law. If it meets the requirements, you are deemed to have a developmental disability and become eligible for OPWDD services. (Please note: additional steps, such as enrolling in Medicaid, are needed to gain access to most supports and services.)
Depending on the complexity of your condition, the process for obtaining an eligibility determination may require reports from multiple specialty assessments. A face-to-face interview may also be part of this process.
The request for TABS ID and Transmittal for Determination of Developmental Disability form must accompany all requests sent to the DDRO for eligibility determinations. Eligibility requests and supporting documentation must be sent to the Eligibility Coordinator at the DDRO where you live.
What is the Eligibility Determination?
Each person who wants OPWDD supports and services has the right to an individual eligibility review. That review will determine whether he or she has a condition that qualifies – or makes the person “eligible” — for services and supports from OPWDD.
Who may ask for a review of eligibility for OPWDD supports or services?
Individuals or their caregivers, guardians, advocates or Care Managers may apply to get supports and services provided or paid for by OPWDD. The application and review process is called the Eligibility Determination Process.
Who decides whether a person is eligible for OPWDD services?
OPWDD determines whether a person has a developmental disability and meets all the conditions of eligibility for OPWDD-funded services.
What is required for a person to be eligible for OPWDD services?
In order for a person to be eligible for OPWDD services, New York State Mental Hygiene Law requires:
1. The presence of a developmental disability that is described by certain qualifying diagnoses or conditions,
2. The disability occurred before the person reached age 22,
3. The disability can be expected to continue indefinitely or permanently, and
4. The disability causes a substantial handicap to a person’s ability to function normally in society.
What are developmental disabilities?
Developmental disabilities are special conditions that may occur anytime from before a baby’s birth up until the age of 22. A developmental disability may take different forms. Developmental disabilities are different from “developmental delays” that show up as a lag in one or more areas of growth or skill. Developmental delays can be reduced by providing Early Intervention services and Special Education services, including special help in the classroom. A developmental disability may cause a child to develop more slowly, or to have physical difficulties and limitations, or have trouble learning and growing, and continues throughout the person’s life. Sometimes a person has more than one condition or disability that qualifies as a developmental disability.
Developmental disabilities that qualify a person for OPWDD eligibility include, but are not limited to, intellectual disability, autism, cerebral palsy, epilepsy, familial dysautonomia, Prader-Willi syndrome, and neurological impairment (injury, malformation or disease involving the central nervous system).
Source: CDC.GOV
Wellbound Knowledge Base
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