Medicaid & Waivers in New York
Medicaid is the spine of disability services in NY. Whether you need home care, day services, residential supports, or a way to keep Medicaid past 18 — the right waiver opens the right door.
OPWDD HCBS Waiver (the big one)
For people with developmental disabilities. Pays for Community Habilitation, Day Hab, Self-Direction, residential supports, respite, and more. You must be OPWDD-eligible first; the waiver follows.
- •Eligibility runs through OPWDD's Front Door (1-866-946-9733).
- •Once OPWDD-eligible, enroll with a Care Coordination Organization (CCO) to get a Care Manager.
- •The Life Plan is what unlocks specific waiver services — keep it specific and updated.
Children's Waiver (HCBS for kids)
For children under 21 with serious medical, developmental, mental health, or trauma needs. Run by Health Home Care Managers, not OPWDD CCOs.
- •Target populations: medically fragile, developmental disability, SED (mental health), child welfare.
- •Apply through a Health Home Care Management Agency (CMA) — your pediatrician or county DOH can refer.
- •Services: respite, caregiver/family supports, community habilitation, prevocational, supported employment.
Care at Home (CAH) — keep Medicaid as a child despite parental income
Lets disabled children stay on Medicaid based on the child's income alone, not the parents'. Often the only way a middle-class family with a complex child can access Medicaid services at home.
- •Requires a level of care determination (hospital, nursing, or ICF/IID level).
- •Apply through your Local Department of Social Services Medicaid office.
MLTC (Managed Long-Term Care) for adults
For adults 18+ who need 120+ days of community-based long-term care and have Medicaid. Choose a plan; the plan manages personal care, CDPAS, adult day, and home care.
- •Call NY Medicaid Choice (1-888-401-6582) for assessment and enrollment.
- •CDPAS lets the consumer hire and direct their own aide — often a family member.
NHTD & TBI Waivers
Nursing Home Transition & Diversion (NHTD) and Traumatic Brain Injury (TBI) waivers help adults with physical disabilities live in the community instead of an institution.
- •Both require nursing home level of care.
- •Apply through your Regional Resource Development Center (RRDC).
Spend-down and Pooled Income Trusts
Over the Medicaid income limit? A Pooled Income Trust lets you deposit excess income each month and still qualify for community Medicaid. Used widely with MLTC.
- •Set up through a nonprofit pooled trust (NYSARC Trust, Center for Disability Rights Trust, others).
- •Trust deposits pay your bills; what's left at death stays with the trust to benefit other members.
Special Needs Trusts (SNTs)
- •First-Party SNT: holds the disabled person's own money (e.g. lawsuit settlement, back-SSI). Must repay Medicaid at death.
- •Third-Party SNT: holds gifts/inheritance from family. No Medicaid payback.
- •Pooled SNT: nonprofit-managed; lower minimums, faster to set up.
- •Set up before the asset arrives — getting money in your name first can disqualify benefits.
Frequently asked
- If we're middle class, can we still get Medicaid for our disabled child?
- Often yes — through the Care at Home waiver or, after OPWDD eligibility, through the OPWDD HCBS Waiver. Both look at the child's income only.
- What's the difference between OPWDD services and Medicaid?
- OPWDD services are paid for by Medicaid (specifically the HCBS Waiver). You need both: OPWDD eligibility for the door, Medicaid enrollment for the funding.