Securing OPWDD approval is the first step toward getting the support your loved one needs. This process ensures access to essential services that can improve quality of life and provide long-term assistance. 

While it may seem daunting, with the right guidance, you can navigate it with confidence. And here at Hamaspik, we're here to help you every step of the way.

Yehudis Heimfeld has been working in intake at Hamaspik for 15 years. She's distilled her in-depth knowledge and vast experience in helping families navigate the OPWDD approval process into this step-by-step guide.

If you’re new to OPWDD, you might be wondering: Where do I even start? The good news is, it all begins with a simple phone call. From that first conversation, we’ll help figure out if your child is eligible, assist in gathering the right paperwork, and guide you through the approval and enrollment process.

Wondering what, exactly, will happen? Let’s take it step by step.

Step 1: The Initial Call

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The first step in getting OPWDD approval is reaching out to Hamaspik. When you call, you’ll speak with an intake specialist.

During this call, we’ll ask you a few key questions to see if your child meets OPWDD’s eligibility criteria. These questions help us understand your child’s diagnosis, their level of functioning, and what kind of support your child might be eligible to receive through OPWDD.

Once we determine that your child meets the initial requirements, the next step is gathering the necessary paperwork. If any evaluations are missing, we’ll guide you on where to obtain them. Our aim is to streamline this process, ensuring you can focus on securing the best support for your child without unnecessary stress.

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Step 2: Determining Eligibility

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OPWDD has specific rules about who qualifies for services. To be eligible, a person must meet three key conditions:

1. Diagnosis Requirement – The individual must have one of the following conditions:
   
   • An intellectual disability (IQ of approximately 70 or below)
   • Autism
   • A neurological condition that affects the central nervous system, such as:
     
     • Cerebral palsy
     • Epilepsy
     • Familial dysautonomia
     • Muscular dystrophy
     • Prader-Willi syndrome
     • Spina bifida
     • Traumatic brain injury (TBI)
     • Other closely related conditions that impair intellectual or adaptive functioning
2. Adaptive Behavior Score – In addition to having a qualifying diagnosis, the individual must have significant challenges in at least two of these areas:
   
   • Communication skills
   • Motor skills
   • Socialization skills
   • Daily living skills, like getting dressed, eating, or personal hygiene
3. Onset Before Age 22 – OPWDD requires proof that the disability started before age 22. This could be early medical records, school evaluations, or developmental history. No matter how old the individual is now, as long as there is documented proof that the disability was present before age 22, they can be eligible for OPWDD services at any age.

If your child meets all three of these criteria, we can move ahead with the application. If any evaluations are missing or need updating, we’ll help you figure out what’s needed.

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Step 3: Gathering Documentation

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Once it’s determined that it’s likely that the individual will be eligible for OPWDD, the next step is gathering the necessary documentation. This includes:

• A psychological evaluation, which includes IQ and adaptive behavior testing
• A psychosocial evaluation that details the individual’s developmental history
• A medical report from a physician confirming the diagnosis
• Any additional supporting documents, such as school records, therapy reports, or previous evaluations

At Hamaspik, we work closely with families to gather all necessary documentation and ensure nothing is missing. If additional evaluations are needed, we provide clear guidance on where to obtain them. Our goal is to streamline the process and prevent any unnecessary delays in securing OPWDD approval.

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Step 4: Submitting to OPWDD

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Once all the necessary documentation is gathered, it is submitted to OPWDD through a Care Coordination Organization (CCO). The CCO plays a crucial role in managing the submission process and ensuring all required forms are completed accurately.

Hamaspik works with three CCOs in our region, and we’ll help you choose the one that best fits your needs. The CCO will then submit the documentation to OPWDD for review.

Within 30-90 days, you should receive a response from OPWDD. If your child is deemed eligible, OPWDD will schedule a Child and Adolescent Needs and Strengths (CANS) assessment, usually conducted via Zoom, to further evaluate your child’s needs and determine service levels.

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Step 5: The CANS Assessment

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The Child and Adolescent Needs and Strengths (CANS) assessment is an important part of the OPWDD approval process. 

This evaluation, conducted by a trained assessor, helps determine the level of support and services your child may qualify for. The assessment typically takes place via Zoom and includes questions about your child's strengths, needs, and daily functioning.

The CANS assessment is designed to ensure that your child receives the appropriate level of care and services. During the CANS assessment, a trained evaluator will ask questions about your child’s daily functioning, communication, socialization, and ability to perform everyday tasks. 

The assessment typically takes about an hour and is conducted in an interview format. Parents and caregivers provide insight into the child's strengths and needs. The evaluator may also ask about the child's medical history, daily routines, problem-solving abilities, emotional regulation, and any challenges they face in social or educational settings. 

Additionally, the assessor may observe how the child responds to different situations, helping to determine the level of support they require. The results help determine the appropriate level of care and services, ensuring the best possible support for your child.

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Step 6: Medicaid and Care Management

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Once OPWDD determines your child is eligible, they generate a Level of Care Eligibility Determination (LCED). This document helps OPWDD decide if your child qualifies for long-term services under the Home and Community-Based Services (HCBS) waiver. It looks at their medical needs, daily functioning, and level of support to ensure they get the right services. An LCED must be completed before your child can receive certain OPWDD services.

The next step is getting them into care management. If your child already has Medicaid, the Care Coordination Organization (CCO) will take care of enrolling them in services.

If your child is under 8, they will receive provisional eligibility. This means they can access services now, but they must reapply at age 8 with updated psychological, social, and medical evaluations to confirm their lifelong eligibility.

If your child does not have Medicaid, the process takes longer. The CCO cannot enroll them in care management yet. 

First, they’ll help you apply for an OPWDD waiver service(s.) If the waiver is approved, you can then apply for Medicaid for just your child through a special “deeming” process, which allows them to qualify without considering your income. This lets them keep your family's primary insurance while also getting OPWDD services.

Once Medicaid is in place, the CCO can start care management, and your child can begin receiving services. Since the services were already approved, this part moves quickly. But the Medicaid process itself can take several months longer than if your child had Medicaid from the start, so it’s best to begin as soon as possible.

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Step 7: Applying for Services

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After Medicaid and care management are in place, the next step is selecting and applying for OPWDD services. The care manager will work closely with you to understand your child’s specific needs, strengths, and goals, ensuring they receive the most appropriate support. 

This process includes discussing different service options, such as:

• Respite Services – Temporary care to give family caregivers a break while ensuring the individual receives the necessary support.
• Community Habilitation – Support that helps individuals build skills in daily living, socialization, and independence within their community.
• Day Habilitation – Structured programs that provide skill-building activities, social engagement, and recreational opportunities during the day.
• Residential Programs – Housing options for individuals who require full-time care and support in a supervised setting.

The care manager will guide you through the application process, making sure that all necessary forms and documentation are completed correctly to avoid delays. They will also help you navigate eligibility requirements and advocate on your behalf if additional information is needed.

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Step 8: Receiving Services

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Once OPWDD approves the requested services, the care manager will assist in identifying and connecting you with qualified service providers. Families have the flexibility to choose different providers for each service, depending on availability, location, and personal preference. Some key aspects of this step include:

• Provider Selection – Families can review different service providers, visit program locations, and ask questions to find the best fit for their child.
• Scheduling and Coordination – The care manager helps arrange schedules and coordinate services to ensure seamless support for the individual.
• Monitoring and Adjustments – Once services are in place, ongoing care management ensures that the individual continues to receive the best possible support. If a service is not meeting their needs, adjustments can be made to explore different options.

The goal of this step is to ensure that individuals receive high-quality, consistent care that enhances their well-being and independence. With continued care management, families can feel confident that they have the support and resources they need at every stage of their journey.

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A Strong Start for Lasting Care

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Navigating the OPWDD approval process may seem complex, but with the right support, it becomes much more manageable. Every step—determining eligibility, gathering documents, applying for Medicaid, and selecting services—brings you closer to securing the care your loved one deserves. While the process can take time, each step ensures that individuals receive the services that best meet their needs.

At Hamaspik, we're here to support you every step of the way with expertise and care. If you have questions or need assistance, help is always available. Keep moving forward with confidence—your persistence makes a difference, and with the right resources, your loved one can access the care and opportunities they deserve.

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