New York State ABA Waiver Income Limits: What Families Need to Know

What Is the New York State ABA Waiver?

The New York State ABA waiver is a Medicaid-funded program that provides applied behavior analysis (ABA) therapy to children with autism spectrum disorder (ASD). It is part of the state's Home and Community-Based Services (HCBS) waiver, administered by the Office for People With Developmental Disabilities (OPWDD). This waiver allows children to receive intensive behavioral therapy in their home, school, or community settings, often at no cost to families.

ABA therapy is widely recognized as an evidence-based treatment for autism, helping children develop communication, social, and daily living skills. The waiver covers a range of services, including one-on-one therapy, parent training, and behavior management plans, all delivered by Board Certified Behavior Analysts (BCBAs) and supervised therapists.

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Income Limits: The Key Facts

Many families worry that their income will disqualify them from the ABA waiver. Here is the good news: the waiver does not have a strict income limit for the child's eligibility in the way you might expect. Instead, it follows standard Medicaid rules, which focus on the child's own income and resources, not the parents'.

How Income Is Determined for the Child

For children under 18, Medicaid eligibility for the ABA waiver is based on the child's individual income and assets. In most cases, children have little to no income of their own, so they automatically qualify. The federal poverty level (FPL) for a single person in 2025 is about $15,060, but the child's income limit is typically much lower-often around $1,000 per month from sources like child support or Social Security benefits. Parents' salaries, savings, or home equity are generally not counted.

What About Parental Income?

New York uses a 'deeming' process for some Medicaid categories, but for the HCBS waiver for children with autism, parental income is usually not considered. This means even if you have a middle-class or higher income, your child can still qualify for the waiver if they meet the medical and functional criteria. However, if you apply for Medicaid through a different pathway, such as the Child Health Plus program, income limits may apply differently.

Eligibility Requirements Beyond Income

Income is just one piece of the puzzle. To get the ABA waiver, your child must also meet these criteria:

• Diagnosis: A formal diagnosis of autism spectrum disorder from a qualified professional, such as a developmental pediatrician or psychologist.
• Medical Necessity: A need for ABA therapy as determined by a BCBA or physician, often documented in a treatment plan.
• Residency: You must be a New York State resident.
• Age: The waiver typically covers children up to age 21, though some programs extend to older individuals.
• Disability Status: Your child must have a developmental disability as defined by OPWDD, which includes autism.

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How to Apply for the ABA Waiver

Applying for the waiver can feel overwhelming, but breaking it into steps helps. Here is a practical guide:

Step 1: Get a Diagnosis

If your child does not already have an autism diagnosis, schedule an evaluation with a specialist. Many pediatricians can refer you to a developmental clinic or a psychologist who specializes in autism assessments. Keep copies of all reports.

Step 2: Contact Your Local OPWDD Office

The Office for People With Developmental Disabilities (OPWDD) manages the waiver. Find your local office through the OPWDD website or call their helpline at 1-866-946-9733. You will need to submit an application for services, which includes a 'Front Door' intake process.

Step 3: Apply for Medicaid

If your child is not already on Medicaid, you will need to apply through the New York State of Health marketplace or your local Department of Social Services. Explain that you are seeking the HCBS waiver for autism. The application will ask about your child's income and resources, but remember, your income as a parent is generally not counted.

Step 4: Complete a Functional Assessment

OPWDD will arrange for a functional assessment to confirm your child's need for services. This may include interviews with you and your child, as well as a review of medical records.

Step 5: Wait for a Waiver Slot

There may be a waiting list for waiver slots, depending on your region and the availability of funding. In some areas, the wait can be months or even longer. While you wait, you can explore other options, such as private insurance coverage for ABA, which is mandated by New York State law.

What If Your Child Does Not Qualify for Medicaid?

If your child's income or resources exceed the Medicaid limit, you still have options. One common approach is a 'spend down'-where you pay for medical expenses out of pocket until your child's countable income falls below the threshold. Another is to apply for a different Medicaid category, such as the 'Medicaid for the Disabled' program, which may have different income rules. Additionally, some families choose to access ABA therapy through private insurance, which must cover autism treatment under New York's mental health parity laws.

Nearby ABA Therapy is a free service that can help you navigate these options and connect you with BCBA-led providers who accept both Medicaid and private insurance. We work with families across New York to find the best match for their child's needs.

Common Mistakes to Avoid

Applying for the ABA waiver can be tricky. Here are pitfalls to watch out for:

• Assuming parental income disqualifies you: As mentioned, your income is usually not counted for the child's Medicaid eligibility. Do not let this stop you from applying.
• Delaying the diagnosis: The waiver process takes time. Start the diagnostic process as early as possible, even if your child is very young.
• Not keeping records: Save all paperwork, including evaluations, letters from doctors, and correspondence with OPWDD. You may need them for appeals or renewals.
• Ignoring the waiting list: If there is a wait, do not give up. Ask about interim services, such as school-based ABA or early intervention programs, which can provide support while you wait.
• Forgetting to renew: Medicaid and waiver eligibility must be renewed annually. Mark your calendar to avoid a gap in coverage.

How the Waiver Works with Insurance

New York State law requires most private insurance plans to cover ABA therapy for autism, with some limits. However, the waiver is designed for families who either do not have insurance or whose insurance does not cover the full scope of needed services. If you have private insurance, the waiver can act as a secondary payer, covering costs that your insurance does not, such as higher hours of therapy or additional parent training.

Medicaid through the waiver typically covers ABA with no copays or deductibles, making it a lifeline for families facing high therapy costs. The waiver also coordinates with other services, such as speech therapy or occupational therapy, to create a comprehensive care plan.

Frequently Asked Questions

We have compiled the most common questions families ask about the NY ABA waiver income limits. See the FAQ section below for quick answers.

Get Matched with a Provider Today

Understanding the waiver is the first step. The next is finding a qualified ABA provider who accepts Medicaid and has experience with the OPWDD system. Nearby ABA Therapy is here to help. Our free matching service connects you with vetted, BCBA-led providers in your area. We handle the research so you can focus on your child's progress. Contact us today to get started.