FAQs

Here you will find the compilation of questions that C4SD has been asked during our
“Office Hours” series.

Housing

  • Yes. When you add housing to the budget, it comes from your existing Personal Resource Allocation (PRA). You don’t get more money—just another option to allocate it.

  • Perhaps not. Some families choose not to apply if the budget is already stretched. It’s a strategic choice in cases where the subsidy might be refused due to you having a less conventional housing situation. This is a good solution if the individual can cover their share of housing from their Social Security payments—or if their family is in a position to help out financially. Any such assistance must be passed through the individual’s ABLE account, or you risk getting a reduction to^p their Social Security payments.

  • It might be possible to secure Section 8 elsewhere and transfer it, but it’s uncertain and needs more exploration.

Community Class Denials & Litigation

  • There’s a letter from OTDA dated May 21 affirming the right to a fair hearing. Grounds for denial must match what’s written in the provider guidance. However, OPWDD hasn’t yet taken proactive action—litigation and court orders may still be necessary.

    1. File for a fair hearing. For more information, refer to c4sd.org/know-your-rights.

    2. Contact IDDO (Independent Intellectual and Developmental Disabilities Ombudsprogram) and ask them to help you prepare. Here is the form: cssny.org/programs/entry/iddo.

    3. The formal criteria are on pages 23 & 24 of OPWDD’s Self-Direction Guidance for Providers.

  • Yes! You do not have to do this, but it will help the cause if you do:

  • When you file for a fair hearing, specify that the class was ‘discontinued’ and ask for ‘aid to continue’. This is the term for continuing to get reimbursement while waiting for the Fair Hearing. Note that you might be required to pay back that money if you lose the Fair Hearing. We believe you should always file for a Fair Hearing when a class is improperly denied. You have a strong case if you can show that the formal criteria were met. And, prior approval creates an even stronger case.

  • Ask for a Fair Hearing. Approval of others but not you is “arbitrary and capricious.” Just…make sure that your LifePlan shows the desire for the Outcome that this class will provide—which could be learning, development, or engagement. Or, all of the above

  • Fill out their intake form: drny.org/intake.php. And then… be prepared to wait. DRNY is finally taking an interest in Self-Direction, but they need to see more requests for assistance. And then… be prepared to wait. DRNY is finally taking an interest in Self-Direction, but they need to see more requests for assistance.

  • Be careful with terminology. If a class was pre-approved and then denied, you must select off “reduction” & “discontinued” to qualify for on-going reimbursement—not “denial.”

    If you filled it out improperly, then reach out to IDDO. They can talk to the Fair Hearing people on your behalf. Here is the form: cssny.org/programs/entry/iddo.

Documentation & Approval Process

  • It’s due to fear. FIs are being cautious to avoid potential financial clawbacks. This fear is sincere. However, C4SD believes, based on our conversations with other States and with Federal authorities, that this fear is not appropriate. For example, in New Jersey, classes that are tailored to the needs of people with IDD are routinely approved.

    However, OPWDD has been telling FIs since November 2022 that they must change their ways of face possible financial ruin. We cannot tell whether the OPWDD fear is sincere, or whether this is a convenient excuse used to make it more difficult for people with IDD to spend money on the services that they need.

  • Ensure your life plan has appropriate justifying language. Currently, in August 2025, people have had success with broad statements:

    • explore creative endeavors.

    • explore technology and science.

    • improve health and fitness.

    • connect with my peers.

    • practice ways to stay calm, regulated, and connected

    This might change in the future. As the ‘System’ continually seeks ways to make it more difficult to access individualized services, one might need to exhaustively list the specifics, such as:

    • “explore creative endeavors, including acting, batik, ceramics, dance, embroidery, floral arrangement, glass-blowing….”

    You get the idea. The problem with the list approach is that you risk leaving out that one really cool thing that you come across months later. For that reason, we recommend the use of broad-stroke statements.

  • Many of these community vendors are run by volunteers or are one-person operations and lack capacity. You can offer to help them create a flyer.

  • Yes. Pages 23 and 24 of the official OPWDD Self-Direction Guidance for Providers spells out what’s required. It is clear and concise. Unfortunately, OPWDD staff have written contradictory statements on their unofficial webpage. As OPWDD revises the Official Guidance in 2026, we must be vigilant about negative changes.

FIs (Fiscal Intermediaries)

  • Consider switching FIs—but many are closed to new cases. File for a fair hearing! Contact your legislator’s constituent services and tell them that you are stuck with a Fiscal Intermediary that is not helping you. To find the constituent services phone numbers at the offices of:

  • Yes. Some of them have a strong commitment to helping people with IDD create individualized programs that provide them with meaning and dignity. When parents sit around over coffee, some of the ones that get the best ‘score card’ are AIM, CFS, and ISS-NY.

    Other FIs seem to be very scared, or perhaps are more interested in getting more people to attend the DayHab programs that they run. It is so hard to tell what someone’s real motivation is. The participants in those same coffee klatches express dissatisfaction with Braverhood, Hamaspic, CMA, and EOC.

  • No, not yet. The Fear is anticipatory. And we believe, ill-founded. C4SD has reached out to the NYS Office of the Medicaid Inspector General, and they have promised to seek our input into their audit protocols. And meanwhile, Fiscal Intermediaries can point to a growing body of Fair Hearings and court cases, to justify their approval of classes that are similar.

  • Yes! However, these had nothing to do with Community Classes or with any aspect of Self-Direction. The opposite: Federal authorities alleged that the New York State executive had engaged in a systematic program to overcharge the Federal Government for Certified Services. See the 2012 NYT article, Medicaid Overpaid New York on Disabled Care, U.S. Says See 2013 Federal report Billions of Federal Tax Dollars Misspent on New York’s Medicaid Program.

    In another case, in 2011, the officers at a prominent provider of Certified Services were alleged to have behaved “improperly” and to have received “Medicaid funding to which it was not entitled.” https://archives.fbi.gov/archives/newyork/press-releases/2011/manhattan-u.s.-attorney-announces-18-million-civil-fraud-settlement-with-new-yorks-largest-operator-of-facilities-for-adults-with-developmental-disabilities

    Historically, Federal clawbacks occurred when investigators have found that funding meant to benefit people with IDD were instead being used for other purposes. In contrast, Community Classes directly benefit people with IDD, enabling them to lead meaningful, dignified lives.

Medicaid Cuts

  • Probably, but it’s not clear yet. The state decides where to cut. Families should advocate with legislators.

Staff and Class Logistics

  • Push back when it’s excessive. Some FIs are more flexible. Documentation requirements vary by FI.

  • Yes, that’s what staffing support roles are for. Ask your broker to include it in your budget.

Switching FIs

  • Yes, but most are closed right now, due to weird NYS contract law. Long term, we need to get an exception to that law.

    Short term, if you are stuck at an FI you don’t like, let your State Legislators know. OPWDD recently distributed new contracts to FIs, but they mostly gave just barely enough money to clear out the waiting list. Now a new waiting list will be accumulating for the next three years—you probably will not be able to switch unless there is a vacancy because someone moves out of the State.

    C4SD will be pushing for a change to NYS Law—you can help make the case for change. Start by taking five mintutes to talk to constituent services at the offices of your representatives. Let them know that you have a problem: