What happens if we’re denied OPWDD eligibility?

If your child is denied for OPWDD eligibility, or denied specific waiver services, you can file an appeal. If you're working with a care manager, they can help guide you through the appeal process.

Understanding why you were denied is crucial. In most cases, the decision is connected to the specific diagnosis, the documentation provided, or the way your child’s daily limitations were presented. If anything is unclear, contact your OPWDD regional office, to clarify the reason for the denial and ensure you understand exactly what led to the decision.

Appealing the state's decision is done through a Fair Hearing, a formal process through which you're given the opportunity to present your case and have it reviewed by a judge. 

You must request the hearing within 60 days of the date on your denial letter. You can request the hearing online at https://otda.ny.gov/hearings or by phone at 1-800-342-3334.

You’ll receive a hearing date and instructions on what documentation to submit in advance of the hearing.

To make a strong appeal, collect all relevant documentation and letters from your child’s support team. Personal statements about your child’s disability and how it impacts their daily functioning are powerful — include specific examples to paint a clear picture. 

At the hearing, you’ll present your updated documentation, timelines, and clear justifications for why your child should be approved despite being found previously ineligible. Ensure your documents are organized and that you feel prepared to explain your child’s needs. 

In strong cases, appeals are often successful. Advocating with clear documentation and a well-prepared case can make a tangible difference in securing the support your child needs.