New York family guide

New York Medicaid waivers for children with disabilities

New York has two main Medicaid waiver paths for children: the Department of Health's Children's Waiver, for kids under 21 with serious medical, behavioral health, or developmental needs, and OPWDD's Comprehensive HCBS Waiver, for children and adults with a developmental disability. Which door you knock on first depends on your child's needs and whether they already have Medicaid, and this guide shows you exactly where each door is.

Last verified: September 2026

Which program fits? How to apply

Start here

The short answer

  • If your child has a developmental disability (for example autism, cerebral palsy, intellectual disability, or epilepsy), call the OPWDD Infoline at 866-946-9733 and ask to be transferred to your county's Front Door office.
  • If your child is under 21, has serious medical or mental health needs, and does not have Medicaid, make a referral to the Department of Health's C-YES program: 1-833-861-4467 or the online C-YES referral form.
  • If your child already has Medicaid, ask a Health Home Serving Children in your county for a Children's Waiver eligibility determination. Use the state's Find a Health Home map.
  • Do not let family income stop you from asking. Both waivers have rules that can look past parents' income for an eligible child (details below).
  • Start gathering records now: evaluations, medical reports, school plans, and any SSI letters. Every path runs on documents.

This guide is general information, not medical or legal advice. The state agencies make every eligibility decision, so please confirm details with them using the contacts on this page.

Programs at a glance

The five pieces of the New York puzzle

Two are waivers. The others are the care management and Medicaid pieces that make the waivers work. Children in either waiver must have a care manager, which is why Health Homes and Care Coordination Organizations matter so much.

Waiver - NYS Department of Health

NYS 1915(c) Children's Waiver

Who it is for
Children and youth under 21 who are enrolled in Medicaid or eligible for it, and who are at imminent risk of hospitalization or institutional placement, or need support to come home from one. They must fit a target population: Serious Emotional Disturbance, Medically Fragile, Developmental Disability and Medically Fragile, or Developmental Disability and in Foster Care.
What it can help with
Community Habilitation, Caregiver/Family Advocacy and Support, planned and crisis respite, prevocational services and supported employment (youth 14 and older), palliative care, environmental and vehicle modifications, adaptive and assistive technology, non-medical transportation, and, since April 1, 2026, Transitional Care Coordination and Transitional Services.
How you get on it
Referral and eligibility determination. With Medicaid: a Health Home Serving Children. Without Medicaid: the state's C-YES program, which also helps you apply for Medicaid.
Official page

Waiver - OPWDD

OPWDD Comprehensive HCBS Waiver

Who it is for
Adults and children with a developmental disability that began before age 22, is expected to continue indefinitely, and is a substantial handicap. The person must also need an ICF/IID level of care, live in New York in an allowed living arrangement, be enrolled in Medicaid, not be in another waiver, and show a need for at least one waiver service.
What it can help with
Community Habilitation, Respite, Family Education and Training, Intensive Behavioral Services, Assistive Technology - Adaptive Devices, Environmental Modifications, Vehicle Modifications, self-direction supports (Fiscal Intermediary, Support Brokerage, Individual Directed Goods and Services), and employment and residential services, among others.
How you get on it
Application. First the OPWDD Front Door and an eligibility determination, then a care manager gathers the waiver application with you.
Official page

Care management - OPWDD

Care Coordination Organizations (CCOs)

Who it is for
People found eligible for OPWDD supports. Anyone enrolled in the OPWDD waiver must have OPWDD care management.
What it can help with
Two options. Health Home Care Management coordinates developmental disability services along with health and behavioral health care. Basic HCBS Plan Support is a minimal option that does not coordinate health or mental health care. Care managers build and maintain your child's Life Plan.
How you get on it
Referral. The Front Door connects you with a CCO, and OPWDD's Find a Care Manager tool lists the seven CCOs by county.
Official page

Care management - NYS Department of Health

Health Homes Serving Children

Who it is for
Children enrolled in Medicaid who meet Health Home criteria, such as two or more chronic conditions, or one qualifying condition like Serious Emotional Disturbance, complex trauma, or sickle cell disease. All children eligible for Children's Waiver services can get Health Home care management.
What it can help with
A care manager who works with your family and providers, completes the Children's Waiver eligibility determination for children who have Medicaid, and helps connect you with waiver providers. The state puts it simply: a Health Home "is not a place, it is a person."
How you get on it
Referral. Contact a Health Home in your county directly, or ask your doctor, managed care plan, hospital discharge planner, or local Department of Social Services.
Official page

Foundation - NY Medicaid

New York Medicaid (including Family of One)

Who it is for
Both waivers require Medicaid. For the Children's Waiver, "Family of One" budgeting counts only the child's income (and resources if certified disabled). For the OPWDD waiver, a child under 18 can ask that parental income and resources not be counted, after a complete waiver application is submitted.
What it can help with
Health coverage itself, and the key that unlocks waiver services and care management.
How you get on it
Application through NY State of Health, a managed care organization, or your Local Department of Social Services. If your child is headed for the Children's Waiver without Medicaid, C-YES helps with the application.
Official page

Interactive

Which program should I ask about?

Answer four quick questions and we will highlight the program cards above that are worth asking about. This is a starting point only. The state agency makes the actual determination, and your child may qualify for more, or less, than this suggests.

How to apply

How to apply, step by step

There are two tracks. Many families with a child who has a developmental disability start on the OPWDD track. Families whose child's biggest needs are medical or behavioral usually start on the Children's Waiver track. If you are unsure, it is reasonable to contact both.

Track A: OPWDD

  1. Call the Front Door. Call the OPWDD Infoline at 866-946-9733, tell the operator what county you live in, and ask to be transferred to your local Front Door office.
  2. Get connected to a CCO. The Front Door connects you with a Care Coordination Organization or service access agency, which helps you gather eligibility documents.
  3. Eligibility review. OPWDD checks that the request is complete (1st step), may send it to a committee of clinicians (2nd step), and offers an independent third-step review if you disagree with a denial. You get the outcome in writing.
  4. Build the Life Plan. Your care manager holds Life Plan meetings and documents the services your child needs. Families of children under 3 must use Early Intervention first, if available.
  5. Apply for the waiver. The care manager collects the waiver application, your signed Documentation of Choices, Medicaid information, a level of care determination, and a request for service authorization, and submits them to OPWDD.

Track B: Children's Waiver

  1. Check Medicaid status. This decides who does the eligibility determination. Not sure? The NYS Medicaid Helpline is (800) 541-2831.
  2. No Medicaid: refer to C-YES. Submit the C-YES online referral, call 1-833-861-4467 (local 518-408-5358), or email CYESConnect@health.ny.gov. Parents can refer their own child.
  3. Has Medicaid: contact a Health Home. Pick a Health Home Serving Children in your county from the Find a Health Home map and ask for an HCBS eligibility determination.
  4. The determination. The care manager reviews your child's documents and completes the assessment. You should be notified of the decision within 5 business days of it being finalized, in a written Notice of Decision.
  5. Enrollment and services. If a waiver slot is available, your child is enrolled and your care manager helps you choose providers. If your child needed Medicaid, C-YES sends you the application and explains how to finish it with your Local Department of Social Services.

Want a wider view first? Our Medicaid waiver state finder compares programs across states, and the therapy and equipment cost explorer can help you describe your child's needs in real numbers.

No sugarcoating

The waiting list, honestly

Federal rules let each state choose the maximum number of people a waiver will serve. When a waiver's slots are full, children can end up waiting. Here is what New York's official sources actually say.

Children's Waiver

When New York combined six children's waivers into one Children's Waiver on April 1, 2019, the Department of Health says it "eliminated the use of waiting lists related to HCBS capacity." At the same time, the state's current eligibility and enrollment policy explains that the CMS-approved waiver sets the number of slots available each year. If a child is found eligible and no slot is open, the child is placed on a waitlist until capacity becomes available.

What that means for you:

  • You still receive a written Notice of Decision even when no slot is available, and your care manager sends an updated letter when one opens.
  • For a child without Medicaid, a slot is placed on hold while Medicaid enrollment is completed.
  • The state does not publish a wait time on the pages we reviewed, so we will not guess at one. Ask your care manager or C-YES where your child stands.

OPWDD Waiver

The OPWDD pages and directive we reviewed do not describe a waiting list for enrolling in the waiver. Instead, they describe gates: OPWDD eligibility, a level of care determination, Medicaid, and a documented need for at least one waiver service (generally at least monthly, or monthly monitoring by a care manager). Each gate takes paperwork and time, which is its own kind of wait.

Why to start now, even if you are unsure

  • Eligibility is built on records, and some must be recent. OPWDD asks for a general medical report and a social evaluation completed within the past 12 months.
  • If your child is found ineligible for the Children's Waiver, a new assessment can be completed whenever your child's circumstances change. The state says there is no wait period between assessments.
  • OPWDD eligibility opens more than the waiver. It is the doorway to care management and other OPWDD supports.
  • If the answer is no, you still learn what else exists. C-YES points families who do not qualify to other supports, such as county mental health services and OPWDD.

A suggestion, in your own words

What to say when you call

Suggested call script

"Hi, my name is ______. I live in ______ County. I am calling about my child, ______, who is ______ years old and has ______.

We need help at home with ______, and I would like to find out whether my child may be eligible for [OPWDD services and the HCBS Waiver / the Children's Waiver].

My child [does / does not] have Medicaid right now.

Could you tell me the next step, what documents you need from me, and who my contact person will be? Can you also tell me how I will receive the decision in writing?"

Write down the date, the name of the person you spoke with, and anything they ask you to send. Keep every letter you receive.

Documents to start gathering

For OPWDD eligibility (from OPWDD's official list):

  • Psychological report with an assessment of intellectual functioning (IQ test)
  • Report of a standardized adaptive behavior assessment
  • Medical or specialty reports for disabilities other than intellectual disability
  • General medical report from the past 12 months
  • Records showing the disability began before age 22
  • Social evaluation from the past 12 months
  • Helpful extras: IEP, 504 Plan, school records, mental health evaluations

For the Children's Waiver (your care manager will guide you):

  • SSI certification or a state Disability Review Team certificate, if your child has one (medically fragile pathway)
  • An LPHA Attestation Form signed by a licensed practitioner (Serious Emotional Disturbance pathway)
  • Documentation that your child is in foster care (Developmental Disability and Foster Care pathway)
  • Your child's Medicaid information, if they have it

Condition-specific guides can help you describe daily needs: autism spectrum disorder, cerebral palsy, and Down syndrome.

Questions families ask

Frequently asked questions

Does our family income keep my child out of a New York waiver?

Not necessarily. For the Children's Waiver, "Family of One" budgeting counts only the child's income, and resources if the child is certified disabled. For the OPWDD waiver, a child under 18 who does not qualify for Medicaid because of family income can ask that parental income and resources not be counted, once a complete waiver application has been submitted.

My child has autism. Which program should we contact?

Start with the OPWDD Front Door at 866-946-9733. OPWDD's definition of developmental disability includes autism, as well as intellectual disability, cerebral palsy, epilepsy, neurological impairment, familial dysautonomia, and Prader-Willi syndrome. A child with a developmental disability can qualify for the Children's Waiver only if they are also medically fragile or in foster care.

What is the difference between a Health Home and a CCO?

Both provide care management. Health Homes Serving Children are part of the Department of Health's program and do Children's Waiver eligibility determinations for children who have Medicaid. Care Coordination Organizations work with people eligible for OPWDD supports and offer Health Home Care Management or Basic HCBS Plan Support.

Can my child be in both waivers at the same time?

No. OPWDD's enrollment directive says a person must not be enrolled in or receive services from more than one Medicaid waiver at a time. Your care manager can help you weigh which waiver fits your child best.

What if my child is found not eligible?

For the Children's Waiver, the Notice of Decision explains your fair hearing rights, and you have 60 calendar days from the date of the notice to request a fair hearing. A new assessment can be done whenever circumstances change. For OPWDD, you can meet with staff about the decision, request a third-step review, and request a Medicaid Fair Hearing if you are seeking Medicaid-funded services.

My child is under 3 and in Early Intervention. Can we still apply to the OPWDD waiver?

Yes, but OPWDD requires families of children from birth to 3 to use Early Intervention first, if available. A child in Early Intervention must show a need for monthly waiver services that Early Intervention or other funding cannot meet.

Is there an age limit?

The Children's Waiver is for children and youth under 21. The OPWDD waiver serves both children and adults with developmental disabilities, as long as the disability began before age 22.

Answers are summaries of the official sources listed below. Confirm your child's situation with OPWDD (866-946-9733) or DOH C-YES (1-833-861-4467).

While you wait on the state

Waivers take time, and a family's needs do not pause. Teagan's Crown helps families of children with special needs in the gaps. If you need help with equipment, therapy, or a hard month, you can apply for help. You can also browse our full resource library.

Sources

Where every fact came from

  1. NYS DOH - Overview of 1915c Children's Waiver and 1115 Waiver accessed September 2026
  2. NYS DOH - Children's HCBS Waiver Eligibility and Enrollment Policy #CW0005 accessed September 2026
  3. NYS DOH - Children's Waiver HCBS Amendment Approval (April 7, 2026) accessed September 2026
  4. NYS DOH - Children and Youth Evaluation Services (C-YES) accessed September 2026
  5. NYS DOH - Update to C-YES Transition Referral Process (January 29, 2026) accessed September 2026
  6. NYS DOH - Children's Home and Community-Based Services brochure (PDF) accessed September 2026
  7. NYS DOH - Information for Children/Youth and Families accessed September 2026
  8. NYS DOH - HCBS Eligibility, Services, and Plan of Care accessed September 2026
  9. NYS DOH - Medicaid Health Homes accessed September 2026
  10. NYS DOH - Find a Health Home accessed September 2026
  11. NYS DOH - Medicaid in New York State (Medicaid Helpline) accessed September 2026
  12. NYS DOH - How to Apply for NY Medicaid accessed September 2026
  13. OPWDD - Front Door accessed September 2026
  14. OPWDD - Get Started accessed September 2026
  15. OPWDD - Eligibility accessed September 2026
  16. OPWDD - Care Management accessed September 2026
  17. OPWDD - Find a Care Manager accessed September 2026
  18. OPWDD - Role of the Care Manager accessed September 2026
  19. OPWDD - Home and Community-Based Services Waiver accessed September 2026
  20. OPWDD - Administrative Directive 23-ADM-06R, HCBS Waiver Eligibility and Enrollment (revised July 14, 2025, PDF) accessed September 2026
  21. OPWDD - Eligibility Guidelines: Determining Eligibility for Services (PDF) accessed September 2026
  22. Medicaid.gov - Home and Community-Based Services 1915(c) accessed September 2026

Programs, contacts, and rules change. If something here looks out of date, trust the agency and let us know.

Be that someone

Every child wears a crown.

Teagan's Crown shows up in the gap for children with special needs and the families who fight for them. Your gift helps us keep guides like this free and put real help in real hands.

Donate Apply for help

Teagan's Crown is a nonprofit for children with special needs and their families. 501(c)(3) status in progress.

Where your gift goes

You choose. A child grows.

Pick exactly what your gift supports. Every dollar goes to work for children with special needs and the families who fight for them.

Family in the fight? Apply for help →For children 21 and under. We help the greatest need first.

More help for New York families

Also useful: Medicaid waiver finder, what a year of care costs, and the full resource library.

Link copied