What services can individuals with special needs get with Medicaid?

Families who come to Hamaspik are often surprised by how much support is available to their loved one, and relieved to find out that Medicaid funds a wide range of services for individuals with disabilities in New York State.

‍What services does Medicaid cover for individuals with special needs?

Medicaid covers a wide range of supports and services, including:

• Home and Community-Based Services (HCBS) waiver programs, which encompass many of the core supports families rely on, including respite services, Community Habilitation, Day Habilitation, and residential programs. HCBS waiver services are mainly offered through two waivers: 
  
  • the OPWDD waiver for individuals with developmental disabilities
  • the Children's waiver for children under 18 with developmental disabilities, significant medical needs, or serious emotional challenges
• Care coordination
• Article 16 clinic services (physical, occupational, speech, feeding, and other therapies)

‍Does my loved one need Medicaid to access OPWDD services?

In most cases, yes. 

In our experience, many families contact Hamaspik to begin the OPWDD process before Medicaid is in place — and that's completely fine. If your loved one doesn't yet have Medicaid, we can still help you move forward. When the time comes, the Care Coordination Organization (CCO) assigned to your case will help you complete Medicaid enrollment so you don't have to navigate it alone.

‍Are there special Medicaid provisions for people with developmental disabilities?

Yes. For individuals with developmental disabilities, Medicaid includes specific provisions — including different income and asset limits — designed to make it more accessible.

Some examples:

• For children living at home, parental income and resources is usually not counted when applying for Medicaid to access waiver-funded services
• Financial resources can be placed in a Medicaid-qualifying supplemental needs trust and excluded from Medicaid eligibility calculations
• In New York, people who receive SSI often qualify for Medicaid automatically
• In NY, many adults with disabilities can still keep their Medicaid coverage even after they start working.

Medicaid eligibility rules and available services may change over time. Families should seek professional guidance specific to their situation. 

For official guidance on New York State Medicaid rules for individuals with disabilities, visit OPWDD.ny.gov or health.ny.gov.

Navigating Medicaid and your service options doesn't have to be overwhelming. Hamaspik's service specialists can help you understand what your loved one may qualify for and how to take the next step.