Does Age Really Matter? Understanding the Coordination between Early Intervention and OPWDD Services

By Marc R. Katz, MA and Pamela Kahn-Alperin, MSW

Published in Building Blocks, June 2013

“Does Early Intervention Services impact my child’s enrollment in OPWDD?”
“What OPWDD Services is my child eligible for, when aging out of Early Intervention?
“How do I apply for such services and how long will it take for services to start?”

These are some of the questions asked by parents of young children with global developmental delays, as they embark on the long and tedious process of establishing their child’s eligibility and enrollment for services from The Office for People with Developmental Disabilities (OPWDD).

Parents’ exposure to much needed services for their child begins with Early Intervention (EI), as it offers a comprehensive array of therapeutic and related supports to infants and toddlers with developmental needs. When children with developmental delays age out of EI, when they turn 3, their parents are faced with the new challenge of negotiating the next step they need to take to receive services for their child. OP-WDD offers a separate system of services for which children with disabilities may be eligible, not just when your child ages out of EI, but sometimes simultaneously with EI services.

Even though EI and OPWDD are two separate and distinct systems, the transition between them does not have to be daunting or stressful for parents. With the right information and an understanding of key points regarding the eligibility criteria, parents can take charge of the process, maximizing the services they receive and removing obstacles that could unnecessarily extended the qualification process.

IS MY CHILD ELIGIBLE FOR OPWDD SERVICES BEFORE THE AGE OF 3 YEARS OLD?

Depending on the severity of your child’s delay, he or she may be eligible for OPWDD services. Early Intervention defines a developmental delay when a child fails to meet expected developmental milestones, even though progress occurs in the anticipated sequence (unlike a developmental disability). Should the nature of the child’s delay be defined as a developmental disability then they can access OPWDD services as well. According to the NYS Mental Hygiene Law (the legal base for eligibility determination): A developmental disability is defined as:
- A condition that results in impairment of one’s general intellectual or adaptive functioning
- Can be expected to continue indefinitely
- Constitutes a substantial handicap in one’s everyday functioning
Although OPWDD will determine if an infant or toddler is eligible for services, they are generally provided with provisional eligibility until the age of eight. At that point the family can pursue permanent eligibility for services, by obtaining updated clinical evaluations.

WHAT ARE THE DIFFERENT TYPES OF OPWDD SERVIC¬ES MY CHILD CAN QUALIFY FOR, WHEN ENROLLED IN OR AGING OUT OF EARLY INTERVENTION?

There are two main types of OPWDD funded services: (1) Family Support Services (FSS) and (2) Home and Community Based Waiver Services (HCBS). Enrollment in FSS is generally easier and shorter, which can be helpful in times of crisis, such as when a family member or loved one becomes ill, or when things get difficult at home. HCBS offers a wider range of services than FSS to meet individual and fam¬ily needs, especially as your child ages and his/ her everyday needs change over time. The following are commonly referred services:
- Non-Medicaid Service Coordination (FSS): As a family first learns about OPWDD services, the process of exploring their available options can become overwhelming. This short-term service provides information and linkages to provide easier access to OPWDD services. The service coordinator will primarily focus on Medicaid enrollment to create greater opportunities for Medicaid Waiver services to help the individual live as productively as possible.
- Plan of Care Support Services (PCSS) (HCBS): Since chil¬dren participating in EI receive their own service coordination as well as an Individualized Family Service Plan (IFSP) for their EI services, they are not eligible for OPWDD’s Medicaid Service Coordination (MSC) program. PCSS is an alternative form of service coordination for those children enrolled in EI. PCSS is delivered by a qualified Service Coordinator who assists families to review and update their child’s Individualized Service Plan (ISP) in order to maintain one’s Waiver eligibility and enrollment. Once your child officially ages out of EI, then one can pursue enrollment into the MSC program or remain enrolled in PCSS.
- Family Reimbursement (FSS) offers families who have a member with a disability the opportunity to receive limited reimbursement for various goods and services related to his or her care. In these difficult economic times, many parents are under extraordinary financial stress to provide for the special needs of their child, and welcome the relief that it affords them.
- In Home Respite Services (FSS or HCBS): The focus of this program is to provide much needed relief to families and caregivers. While providing this respite, trained counselors work with children with disabilities on a 1:1 basis, providing socialization and skill building activities.
- Environmental modification & adaptive equipment (HCBS): Specialized equipment, or changes to the living environment can be provided that enable individuals with physical disabilities or limited communication to lead more independent lives. Examples include wheelchair ramps, adaptive strollers and communication devices.

WHY SHOULD I APPLY NOW? WHAT IS THE TIMEFRAME FOR MY CHILD TO RECEIVE OPWDD SERVICES?

In the past, when applying for Medicaid Waiver Services, one first chose a voluntary agency provider. Intake specialists initially assisted families in navigating the maze of the eligibility and enrollment process. Today, the OPWDD system is in the midst of a major transformation, referred to as the Front Door Initiative, with statewide implementation expected in June 2013. Thus, families of children with special needs who are seeking services for the first time now will be the first to use this new process.
The Front Door process guides families through eligibility determination, assessment, identification of service needs, service authorization, and implementation. Families will first contact the OPWDD regional office that covers their county for assistance. Despite the ongoing discussions about redesigning Medicaid Waiver, the eligibility guidelines remain the same. Please see “At a Glance OPWDD Eligibility Guidelines” for more detailed information.

The time frame for determining eligibility and enrollment can vary widely. That process for FSS can take up to 3-4 weeks. However, it takes approximately 5-6 months for a child to be enrolled into Medicaid Waiver services (HCBS). Even though parents may feel that the waiting time is out of their hands, there is a lot that they can do to expedite the process:
- Complete all the required forms and don’t be afraid to ask questions
- Schedule evaluations and submit them in a timely manner
- Ensure accurate reporting of your child’s strengths and needs so that they are accurately reflected in the documented reports
- Make yourself available for meetings and interviews with your intake coordinator to complete required documentation.

For parents of a young child with developmental disabilities, OPWDD Services offers a lifeline of support. Age does not significantly impact your child’s eligibility and enrollment for OPWDD services (regardless of whether your child is enrolled or aging out of Early Intervention). In other words, with regard to OPWDD services, “age is only a number.”

Marc R. Katz, a NYS Certified School Psychologist, is a Director at OHEL Bais Ezra. Pamela Kahn-Alperin, MSW, is also a member of the Senior Management Team at OHEL Bais Ezra.

For more information about evaluations, intake, or referral of services, please call 1.800.603.OHEL, visit www.ohelfamily.org or e-mail access@ohelfamily.org. OHEL delivers a breadth of community and residential services through OHEL Bais Ezra, OHEL Lifetime Care, OHEL Foster Care, OHEL Mental Health Services, OHEL Institute for Training, Camp Kaylie and Etta at OHEL