Understanding Reasonable Indication of Need for HCBS Waiver Services
On July 17, 2023, OPWDD released this Administrative Directive (ADM) on age-related guidelines for HCBS Waiver enrollment or the authorization of community-based habilitation services. OPWDD offers funding for various services to help Members learn and build skills to have meaningful relationships, gain independence, and meet their needs.
Members must enroll in Health Home/Care Management to coordinate HCBS Waiver services to assist members and families in accessing services and supports appropriate to their needs.
HCBS Waiver enrollment
This is based on a Member’s
- OPWDD eligibility
- Active LCED
- New York State residency and residence in an eligible setting (individual’s own home or that of a relative, an OPWDD certified CR, IRA, or family care home)
- Medicaid eligibility
And whether a Member
- Is enrolled in another HCBS Waiver or a managed long-term care plan
- Meets the requirement of Reasonable Indication of Need for Services
What is a Reasonable Indication of Need for Services?
It is defined as an individual’s need for one or more HCBS Waiver services to avoid institutionalization. An individual can only gain access to the waiver when all alternate funding sources have been explored first and when there are no other resources or options. Other sources include natural or community support, early intervention, school support, or Family Support Services (FSS). An individual’s need for the waiver is based on their ongoing need, at least monthly, and the need for respite services alone is an insufficient reason as there are other respite options through natural and community supports.
Options for Accessing Respite
Here are options for accessing respite.
- FSS through Early Intervention for birth to age 3
- FSS through OPWDD eligibility starting at age 3 until no longer needed
- Natural, community, and supports offered by the school district for school-aged youth
School-age youth between ages 5 to 18 years old can access the HCBS Waiver when a reasonable indication of need is demonstrated after natural, community, and FSS have been utilized. An individual with eligibility can be enrolled into the HCBS Waiver when either is a reasonable indication of need and with Care Management. OPWDD services can vary depending on an individual’s circumstances and the availability of natural and community supports.
Check out this video for more information on OPWDD services.