New York Self-Directed ABA Waiver: A Complete Guide for Families
In short: The New York self-directed ABA waiver lets families of children with autism hire their own therapists and manage care. To apply, contact your local Developmental Disabilities Regional Office (DDRO) for eligibility screening, then work with a Care Manager to create a plan. This waiver covers ABA therapy through Medicaid, giving families more control over services.
Key takeaways
- The self-directed ABA waiver is part of New York's HCBS waiver for children with autism, offering flexibility in choosing providers.
- Eligibility requires a diagnosis of autism, Medicaid enrollment, and a need for ABA therapy as determined by a state assessment.
- Families can hire and train their own ABA therapists, including relatives (excluding parents), with state oversight.
- The waiver covers ABA therapy, parent training, and related services, with no out-of-pocket costs for eligible families.
What Is the New York Self-Directed ABA Waiver?
The New York self-directed ABA waiver is a Medicaid program that allows families of children with autism to take control of their Applied Behavior Analysis (ABA) therapy. Instead of relying on a traditional agency, you can hire, train, and manage your own therapists. This waiver is part of the state's Home and Community-Based Services (HCBS) program, specifically the Children's Waiver, which covers autism services for kids under 21.
Self-direction means you decide who provides therapy, when it happens, and how it's delivered. You're not alone, though: a Care Manager helps you create a plan, and a Fiscal Intermediary handles payroll and billing. This approach gives families more flexibility, especially in areas where ABA providers are scarce.
🔗 Related reading: CA Regional Center Autism Services Checklist · Local ABA Therapy
Who Is Eligible for the Self-Directed ABA Waiver?
Age and Diagnosis Requirements
To qualify, your child must be under 21 years old and have a formal diagnosis of autism spectrum disorder (ASD) from a qualified professional, such as a developmental pediatrician or psychologist. The diagnosis must be documented in medical records.
Medicaid Enrollment
Your child must be enrolled in New York State Medicaid. If you're not sure about eligibility, you can apply through the NY State of Health marketplace or your local Department of Social Services. The waiver itself has no income limits beyond Medicaid's standard criteria, but some families may qualify through Medicaid Buy-In for Working People with Disabilities.
Need for ABA Therapy
A state-approved assessment, often done by a Care Manager or a clinician, must show that your child needs ABA therapy. This includes evaluating behaviors, communication skills, and daily living abilities. The assessment determines the level of support required.
How to Apply for the Self-Directed ABA Waiver
Step 1: Contact Your Local DDRO
Start by reaching out to the Developmental Disabilities Regional Office (DDRO) in your area. New York has five DDROs covering different regions: New York City, Long Island, Hudson Valley, Central New York, and Western New York. You can find contact information on the OPWDD website. Explain that you're interested in the Children's Waiver for self-directed ABA services.
Step 2: Complete Eligibility Screening
The DDRO will schedule an eligibility screening, which includes a review of your child's diagnosis and a functional assessment. This determines if your child meets the criteria for an intellectual or developmental disability (IDD) under state guidelines. For autism, this often involves a standardized tool like the Vineland Adaptive Behavior Scales.
Step 3: Choose a Care Manager
Once eligible, you'll work with a Care Manager from a Care Coordination Organization (CCO) or a Health Home. This person helps you develop a Person-Centered Service Plan (PCSP) that outlines your child's goals and the services needed, including ABA therapy hours.
Step 4: Select a Fiscal Intermediary
For self-direction, you need a Fiscal Intermediary (FI) to handle payroll, taxes, and billing. OPWDD provides a list of approved FIs. You'll sign an agreement with the FI, and they'll manage payments to your hired therapists.
Step 5: Hire Your Therapists
You can recruit ABA therapists, including Board Certified Behavior Analysts (BCBAs) and Registered Behavior Technicians (RBTs), as long as they meet state qualifications. You can hire family members (except parents or legal guardians) if they're trained. The Care Manager and FI will guide you on background checks and training requirements.
🔗 Related reading: Planning Adult Autism Services Transition in Illinois · Get ABA Therapy
What Does the Waiver Cover?
The self-directed ABA waiver covers a range of services, all paid for by Medicaid with no cost to you. These include:
- ABA therapy: One-on-one sessions with a BCBA or RBT, focusing on skill building and behavior reduction.
- Parent training: Coaching for parents to implement strategies at home.
- Care management: Ongoing support from your Care Manager.
- Respite care: Temporary relief for caregivers, though this may be limited.
- Other supports: Such as transportation to therapy or adaptive equipment, if deemed necessary.
Hours are determined by the PCSP and can be adjusted over time. Typically, children receive 10 to 30 hours per week, depending on need.
Costs and Insurance Considerations
Because the waiver is part of Medicaid, there are no direct costs to families. However, you must maintain Medicaid eligibility. If your income changes, you may need to re-enroll or explore options like the Medicaid Buy-In program. Private insurance may also cover ABA therapy, but the waiver offers more flexibility for self-direction.
If self-direction seems overwhelming, you can still access ABA through traditional providers. Nearby ABA Therapy is a free service that matches families with vetted, BCBA-led providers in New York. We help you find clinics that accept Medicaid and private insurance, so you don't have to navigate the system alone.
Practical Tips for Success
Start Early
The application process can take several months, from screening to plan approval. Begin as soon as your child is diagnosed to avoid delays.
Build a Support Network
Connect with other families using self-direction through local parent groups or online forums. They can share tips on hiring therapists and managing budgets.
Keep Detailed Records
Document all communications with the DDRO, Care Manager, and FI. Track therapy hours and progress notes, as these may be reviewed during audits.
Train Your Therapists
Even if you hire experienced RBTs, provide training on your child's specific needs. The BCBA you hire should oversee the therapy plan and supervise RBTs regularly.
Common Mistakes to Avoid
- Not verifying therapist credentials: Ensure all hired therapists are licensed or certified in New York. BCBAs must be certified by the BACB and registered with the state.
- Ignoring budget limits: Your PCSP sets a budget for services. Overspending can lead to denials. Work with your FI to stay within limits.
- Skipping Care Manager meetings: Regular check-ins with your Care Manager are required. Missing them can delay approvals or renewals.
- Assuming self-direction is easier: It offers flexibility but requires time and organization. If you're overwhelmed, consider traditional providers instead.
If self-direction isn't right for your family, Nearby ABA Therapy can connect you with experienced ABA providers across New York. We match you with clinics that offer in-home, center-based, or school-based therapy, all covered by Medicaid and most insurance plans.
Frequently Asked Questions
We've answered common questions below, but remember that each family's situation is unique. Always consult with your Care Manager or OPWDD for personalized guidance.