An Important Message to our Families and Participants Residing at Home

For the past several months South East has been attempting to better understand and properly implement procedural regulations and related paperwork to obtain reimbursement from New York State and Medicaid. South East is deemed by New York State and Medicaid as a “Respite Service Provider” and this designation has thrown South East into a complex bureaucratic environment. Consequently, South East has encountered problems and concerns it has never experienced before.

Six years ago, New York State converted OPWDD’s financial support to include Medicaid. No one envisioned that this would alter our agency infrastructure and critically strain our limited resources, but it has. These new structures pose real threats. Program staff are consumed with enormous amounts of paperwork which takes away from providing programs and services; various obstacles regarding billing for reimbursement could result in denial of claims which would result in non-payment; there is always the disturbing possibility that harsh penalties could be levied if procedural applications are either misinterpreted or done improperly and, lastly, New York State has a “cap” on its fund allocation to South East which will affect any program expansion and increase in new enrollments.

While South East appreciates the governmental financial support it receives from New York State, we have found this new way of doing business to be stressful, overwhelming and confusing for everyone. In many cases South East provides valuable services to individuals in need, but regulations either delay any reimbursement or deny it altogether. Some would perceive this as New York State realizing a goal of saving money; South East sadly perceives this as denying services because there is no way to pay for them.

So, as we move forward, South East has imposed the following conditions related to enrollment effective this fall:

• If you have not initiated the OPWDD eligibility process to determine eligibility status you will not be permitted to enroll. It’s a tedious, but necessary process and we can help you. 
• If you are recognized as pursuing OPWDD eligibility or Medicaid Waiver (or Self Direction) you may enroll as a Transitional Participant. 
• If you are recognized as being confirmed for OPWDD eligibility and completed the “Front Door” process you must provide South East with all related paperwork before being dropped from Transitional Participant status. 
• If you are recognized as ineligible for OPWDD services meaning South East cannot claim reimbursement from New York State then you may enroll as a Direct Cost Participant if you reside in the South East Consortium catchment area. 
• If you are on Medicaid Waiver or pursuing Medicaid Waiver (also Self-Direction) you will not be permitted to enroll in South East programs until South East is properly listed as a service provider on your ISP and all related documentation is completed. It is the responsibility of parents to ensure your Medicaid Service Coordinator properly lists South East as a service provider and ensures South East receives a copy of the ISP semi-annually. 

Although these conditions may seem drastic and somewhat punitive, they are necessary for South East to stabilize itself to move forward. Be assured our most valued partners are our participants and their families. We will continue to do our best to support you. Please contact our office at (914) 698-5232 for assistance. Kathleen Peters-Durrigan, our Program Eligibility Coordinator, is on staff to help guide you through this process.

Jerry Peters