How New York pays for disability services

Waiver inventory

The Comprehensive Waiver application explicitly checks 1915(b)(4) as a concurrent authority and does not use 1915(i) or 1915(j). New York's ICF/IID level of care applies to 100 percent of the waiver population.

State-only funded programs

• OPWDD Housing Subsidy (Rental Assistance). OPWDD-administered rental assistance for people living in their own home or with roommates in an apartment or private home, outside the Medicaid service rate structure. The subsidy amount is set by a formula considering income, county, household size, and number of bedrooms; recipients must contribute toward rent and live in an allowable unit. Not available in boarding arrangements. Requirements are set out in the Housing Subsidy Administrative Memorandum. Annual appropriation: not found. opwdd.ny.gov
• Integrated Supportive Housing and Empire State Supportive Housing Initiative participation. OPWDD partners with affordable housing developers on dedicated units and participates in ESSHI, a state program operated by the Office of Mental Health, providing support services and housing subsidies to tenants with developmental disabilities who are homeless or at risk of homelessness. Annual appropriation for the OPWDD share: not found. opwdd.ny.gov
• State-funded bonus initiatives for the direct support workforce. Of $2.8 billion invested since 2022, $340 million came through state-funded bonus initiatives (distinct from $1.4 billion in one-time federally approved bonuses and $1.1 billion through three consecutive cost-of-living adjustments). governor.ny.gov
• Family Care room and board. Family Care Providers "are reimbursed for your room and board, for providing residential habilitation services, mileage, and other expenses." The residential habilitation portion is Medicaid; the room and board portion is not, and is drawn from the resident's SSI plus the New York State Supplement. I could not confirm the appropriation or the exact state share from a primary source. opwdd.ny.gov

Approximately 95 percent of OPWDD services are funded through Medicaid, so state-only programming is a small residual. opwdd.ny.gov

County / regional / local funding

• County and New York City local share of Medicaid. OPWDD states directly that "approximately 95% of OPWDD services are funded by the Medicaid program, where the federal government, New York State and local governments each contribute to a share of payment/reimbursement of claims." This makes county and New York City general revenue a structural third leg of OPWDD financing, unusual among states. Geography: all 57 counties plus New York City. Mechanism: statutory local share of Medicaid claims. Scale: not broken out for OPWDD services in any document I retrieved. opwdd.ny.gov
• Regional rate differentials. New York does not have county-run DD boards, but its rate structure is geographically differentiated by DOH region and OPWDD region, which functions as a regional allocation mechanism. Community Habilitation splits Downstate and Upstate; Respite and Family Care Residential Habilitation use four DOH regions; SEMP uses three OPWDD regions. The rate regions are published at health.state.ny.us
• County-level expenditure data is published by OPWDD in its Medicaid Summary. opwdd.ny.gov

Funding scale

• Total OPWDD Medicaid spending, fiscal year July 1, 2023 to June 30, 2024: $10.2 billion ($9.97 billion fee-for-service, $259.7 million managed care through FIDA-IDD). opwdd.ny.gov
• Medicaid HCBS waiver spending in that year: $8.4 billion. Residential services specifically: $5.96 billion, or 58 percent of all OPWDD Medicaid spending. opwdd.ny.gov
• Ten-year trend: 2014, 107,071 people served and $6.6 billion in payments; 2024, 134,686 people served and $10.2 billion. That is a 25.8 percent increase in people and a 54.8 percent increase in spending. opwdd.ny.gov
• State vs federal share: approximately 95 percent of OPWDD services are Medicaid-funded, with federal, state, and local government each contributing. New York's FMAP is 50.00 percent for FY2026, so the non-federal half is split between the state and counties/New York City. opwdd.ny.gov and kff.org
• Spending per participant: $75,864 across all 134,686 people served in 2024 (up from $61,671 in 2014 and $69,820 in 2019). Within the 1915(c) waiver specifically, the approved Factor D per-participant estimate for Waiver Year 1 is $79,057.66 ($77,109.79 not included in capitation plus $1,947.88 included in capitation), against a total estimated waiver cost of $8,261,762,948.07 for 104,503 participants. Average length of stay on the waiver is 358 days. opwdd.ny.gov and opwdd.ny.gov
• People served in DD waivers: the approved waiver capacity is 106,802 unduplicated participants for Waiver Year 2 (10/1/2025 to 9/30/2026). Total people served by OPWDD across all authorities is 134,686 (47,980 children 0-20, 80,679 adults 21-64, 9,684 seniors 65+). opwdd.ny.gov
• Waiting list: not found. OPWDD does not publish a statewide DD waiver waiting list count in any document I retrieved. Access runs through the Front Door / Care Manager process rather than a chronological registry, and the waiver's own capacity table shows unduplicated participant ceilings rising by roughly 2,300 to 2,450 per year rather than a queue. I did not find an explicit state statement that no waiting list exists, so this should be treated as an unverified absence rather than a confirmed zero.

Residential funding detail

What is funded. New York funds four certified residential models plus uncertified independent living:

1. Supervised Individualized Residential Alternative (Supervised IRA), the state's 24-hour group home. 29,475 people lived in supervised group homes with 24/7 staffing in 2024. Paid as a provider-specific daily rate set by the Department of Health Bureau of Mental Hygiene Services Rate Setting under 10 NYCRR 86-10.3, plus a Supervised IRA Acuity Factor.
2. Supportive Individualized Residential Alternative (Supportive IRA), less than 24-hour staffing. 1,873 people in 2024. Paid as a provider-specific monthly rate, plus a Supportive IRA Acuity Factor.
3. Family Care Residences, the state's host home / shared living model. 1,049 people in 2024. Paid as a daily rate by DOH region and by ISPM (Individual Service Plan Methodology) level 1 through 6, a genuinely acuity-tiered structure. Family Care Providers are separately reimbursed for room and board, mileage, and other expenses.
4. Intermediate Care Facilities (ICF/IID), provider-specific rates with separate ICF Day Services and ICF Vocational Services rate tables.
5. Uncertified settings (own home, family home, rented apartment), supported through Community Habilitation, Live-in Caregiver, Home-Enabling Supports assistive technology, home and vehicle modifications, paid neighbor arrangements, and the OPWDD Housing Subsidy. This is where the majority of people receiving OPWDD supports live.

There were 7,037 certified residential sites statewide in 2024.

Payment structure. Residential Habilitation is priced by individual provider, not by a statewide fee, which is the defining feature of the New York system: each of roughly 200 supervised IRA operators and 112 supportive IRA operators has its own published rate reflecting its own cost base, layered with an acuity factor. Day services use provider-specific unit and half-unit prices. Everything else (Community Habilitation, Respite, SEMP, Prevocational, Pathway to Employment, Support Broker, Fiscal Intermediary) uses regionally differentiated statewide fees, not provider-specific rates. Amendment 14 (effective October 1, 2023) deliberately moved rate and fee tables out of the waiver agreement and onto the DOH website so they could be updated more easily.

Room and board. Room and board is not in the Residential Habilitation rate. Residents pay it from SSI plus the New York State Supplement Program. Separately, the DOH rate tables publish a Monthly Room & Board Supplement alongside each provider's Supervised and Supportive IRA rate. As of January 1, 2026 these supplements range from $0.00 for most providers to very large monthly amounts for a minority (for example, Access: Supports for Living, Inc. at $14,880.37 and Adults and Children with Learning and Developmental Disabilities, Inc. at $39,729.87 for Supportive IRA). Family Care room and board is reimbursed to the provider.

Rate structure link: health.state.ny.us

Comparable service rates

Because New York sets residential and day habilitation rates provider by provider, the table below gives the distribution across all published providers rather than a single number.

Official rate schedule links

• OPWDD and Mental Hygiene Services rates index, all periods and service types: health.state.ny.us
• Supervised IRA, effective January 1, 2026 (web and XLSX): health.state.ny.us and health.state.ny.us
• Supportive IRA, effective January 1, 2026: health.state.ny.us
• Group Day Habilitation, effective January 1, 2026: health.state.ny.us
• Intermediate Care Facility (ICF), effective January 1, 2026: health.state.ny.us
• ICF Day Services and ICF Vocational Services, effective January 1, 2026: health.state.ny.us and health.state.ny.us
• Pre-Vocational Services and CRP Fees, effective January 1, 2026: health.state.ny.us and health.state.ny.us
• Supervised and Supportive IRA Acuity Factors, effective January 1, 2026: health.state.ny.us and health.state.ny.us
• Regional averages, effective January 1, 2026: health.state.ny.us
• Community Habilitation, Respite, SEMP, Family Care Residential Habilitation, Community Based Prevocational, Pathways to Employment, Fiscal Intermediary, Support Broker, IBS, CSIDD, Day Treatment, FET, all effective April 1, 2025: health.state.ny.us (change the final filename for each service; index at the Mental Hygiene rates page above)
• Home Enabling Supports fees, effective May 1, 2025: health.state.ny.us
• Additional rate information, rate code list, and 42 CFR 447.203 compliance crosswalks for Day Habilitation, ICF, and IRA: health.state.ny.us
• OPWDD rate regions: health.state.ny.us
• CCO/HH PMPM rates for people with IDD: health.ny.gov
• Full 2024 waiver renewal application, NY.0238.R07.00: opwdd.ny.gov

Notable features and flags

• January 31, 2025: Governor Hochul announced $850 million in updated reimbursement rates for non-profit residential and day service providers, described as more than $400 million in new annual resources from the FY2025 Enacted Budget plus federal funding. Cumulative state investment since 2022 reached $2.8 billion ($1.4 billion in one-time federally approved bonuses, $1.1 billion through three consecutive COLAs, $340 million in state-funded bonuses), or $3.7 billion including the new rate investment. OPWDD supports more than 130,000 New Yorkers. governor.ny.gov
• October 1, 2024: the Comprehensive Waiver was renewed for five years as NY.0238.R07.00, continuing the 2013 Transformation Agreement commitments to reduce institutionalization, with updated quality improvement strategy and revised Appendix J cost projections. Approved capacity climbs from 104,503 to 114,007 unduplicated participants over the five years. opwdd.ny.gov
• April 1, 2025: CMS approved 2025 Waiver Amendment 01, adding a 1915(b)(4) selective contracting authority for Home-Enabling Supports assistive technology services, with a new fee schedule effective May 1, 2025. opwdd.ny.gov
• October 1, 2023 (Amendment 14): permanently adopted several COVID-era flexibilities affecting service rates, remote technology, and limits on agency administrative cost reimbursement; moved rate and fee tables from the waiver agreement to the DOH website; supported a risk-stratified method for on-site visits to certified waiver locations. This is why the current authoritative rates live on health.state.ny.us rather than in the waiver document. opwdd.ny.gov
• Self-direction has more than doubled. Self-direction enrollment rose from 18,000 in 2019 to 37,500 in 2024, a 109 percent increase over five years, and 18,190 of those self-directing in 2024 were children. This is the fastest-moving structural shift in the New York system. opwdd.ny.gov
• Care coordination is consolidated and stable. Seven CCOs cover 123,051 people as of December 31, 2024, with 97 percent in Health Home Services and 3 percent in HCBS Basic Plan Support. 44,895 people new to OPWDD care management have enrolled since CCOs launched in 2018. Initial life plan completion for new enrollees was 86 percent statewide and annual life plan completion was 97 percent; disenrollment was 4 percent (5,204 people). opwdd.ny.gov
• Rate freshness is uneven. As of this research, provider-specific residential and day habilitation rates had been updated to January 1, 2026, but the statewide fee schedules (Community Habilitation, Respite, SEMP, Prevocational, Pathways, Fiscal Intermediary, Support Broker) were still published at April 1, 2025; the April 1, 2026 fee pages existed as links from the index but returned Page Not Found. The DOH index also carries the note "Fees currently pending approval by New York State Division of the Budget." The CCO/HH PMPM rates on the DOH page are still labeled effective April 1, 2023 and pending CMS approval. health.state.ny.us

Confidence

Solid: the provider-level residential and day habilitation rates effective January 1, 2026, which I pulled directly from the DOH rate pages and summarized statistically across 200, 112, and 258 providers respectively; the April 1, 2025 statewide fee schedules for community habilitation, respite, supported employment, and family care; the waiver control number, approval period, and unduplicated capacity table; the Factor D per-participant estimate; and the 2024 spending, service, and residential census figures from OPWDD's own published data. Estimated or dated: the CCO/HH PMPM rates are the most recent published but are labeled effective April 1, 2023 and pending CMS approval, so what plans are actually paid today may differ; the April 1, 2026 fee schedules were not yet posted, so the hourly service rates given here are one annual cycle behind the residential rates. The $79,057.66 Factor D figure is a waiver application projection, not an actual. Could not find: any published statewide waiting list or unmet-need count for OPWDD residential or waiver services; the dollar scale of the county and New York City local Medicaid share attributable to OPWDD; the appropriation for the OPWDD Housing Subsidy; and enrollment for FIDA-IDD and the Consolidated Children's Waiver. The FY2027 Executive Budget briefing book for mental hygiene was not reachable during this session because both the search engines and the fetch proxy were rate-limited.