Medicaid and OPWDD Services: Why It's the Key, and the Ways to Get It

Families sometimes think of Medicaid as health insurance and nothing more. For adults with developmental disabilities in New York, it's much more than that. It's the funding source behind almost all OPWDD services: day programs, Self-Direction, respite, and residential homes. No Medicaid usually means no services.

Common ways adults get Medicaid

Through SSI

In New York, people who receive SSI generally receive Medicaid as well. Since parents' income stops counting toward SSI the month after a child turns 18, many young adults become eligible at that point, even if the family was turned down before. Our post on SSI at 18 explains how that works.

Applying directly

Adults can also apply for Medicaid based on their own income and resources, without SSI. Your local Department of Social Services, or your Care Manager, can help with the application.

If your family member works: the Medicaid Buy-In

Many families worry that a job will cost their son or daughter their Medicaid. New York has a program specifically for this: the Medicaid Buy-In for Working People with Disabilities. It's for people aged 16 to 64 who meet Social Security's definition of disability and are doing paid work, part-time or full-time. It allows much higher income and savings than regular Medicaid. Depending on income, there may be a monthly premium.

The income and resource limits change every year, so check the current figures with your local Department of Social Services or a benefits advisor before making decisions about hours or pay.

Keeping Medicaid once you have it

• Watch your mail. Medicaid has to be renewed periodically. A missed renewal letter is one of the most common reasons coverage lapses, and with it, services.
• Report changes. New jobs, changes in income, or a move can affect eligibility.
• Tell your Care Manager about any letter you don't understand. It's far easier to fix a problem before coverage ends than after.

Sources: NYS Department of Health, Medicaid Buy-In Toolkit; NYS DOH, OPWDD HCBS Waiver; NY Health Access, Medicaid Buy-In for Working People With Disabilities.