New York TBI Waiver Service Problems: Fair Hearings, Aid Continuing, and Official Help
If a New York Medicaid Traumatic Brain Injury (TBI) Waiver service is denied, reduced, suspended, or discontinued, start with the written notice. The notice should identify the decision, effective date, reason, and appeal instructions.
Emergency: Call 911 for an immediate health or safety emergency. This page is educational information, not legal advice.
Start here: the shortest safe path
Read the entire notice. Write down its date, the proposed effective date, the service involved, and the Fair Hearing deadline.
Contact your Service Coordinator and the Regional Resource Development Center (RRDC). Ask for the decision and reasons in writing.
Request a New York State Office of Temporary and Disability Assistance (OTDA) Fair Hearing if you want an independent review of the Medicaid decision.
Ask for “aid continuing” in the same request if existing services are being reduced or stopped. Eligibility is conditional; OTDA decides whether it applies.
Keep proof. Save the notice, care plan, assessments, emails, call notes, fax confirmation, and every document sent or received.
Do not send your Medicaid Client Identification Number (CIN), diagnosis records, Social Security number, or other private health information to ABI Resources. Put identifying information only on the official OTDA form or in a secure communication with the responsible agency.
Fair Hearing, aid continuing, and an RRDC complaint are different
OTDA Fair Hearing
A Fair Hearing asks New York to review an agency decision. Use the deadline and directions on your notice. The official OTDA Fair Hearing request form lists these routes:
Phone: 1-800-342-3334
Fax: (518) 473-6735
Mail: Office of Administrative Hearings, P.O. Box 1930, Albany, NY 12201-1930
Aid continuing
New York regulation 18 NYCRR 358-3.6 describes when benefits or services may continue while a hearing is pending. It is not automatic or unconditional. Timing, the type of action, the notice, and regulatory exceptions matter. Ask before the effective date shown in the notice and state clearly that you request aid continuing. OTDA determines eligibility.
Federal regulation 42 CFR 431.230 also describes conditions for continuation of services. The current notice and official agency instructions control your case.
RRDC complaint or problem report
An RRDC complaint can address waiver-program delivery or a provider/service problem, but it does not replace a Fair Hearing request or extend a hearing deadline. Use New York’s county-by-county RRDC contact list and official TBI waiver complaint process. New York Relay Service is available by dialing 711 or 1-800-662-1220.
Copy-and-adapt request language
Use this only as a preparation aid. Put the final request on the official OTDA form or submit it through an official OTDA method.
Subject: Request for Medicaid Fair Hearing and Aid Continuing, if available I request a Fair Hearing about the decision described in the notice dated [notice date]. The decision concerns [service and amount/hours] and is scheduled to take effect on [effective date]. I disagree because [brief factual reason]. I am asking for [the specific result you want]. I also request aid continuing, if I qualify, so my existing service level can remain in place while the hearing is pending. Please decide this request and confirm the decision in writing. I need the following disability or communication accommodation to participate: [plain-language notices, extra processing time, support person, interpreter, captioning, large print, or other need].
Do not state that aid continuing is guaranteed. Do not claim that every reduction is automatically illegal. Do not demand a medical evaluation unless it is supported by the person’s records and requested by the person or a qualified professional.
Documents to gather
The complete notice and envelope
Current service plan and approved service level
Recent clinical or functional assessments
Provider schedules, missed-visit records, and relevant communications
A short timeline with dates, names, and what happened
The exact accommodation needed to understand or participate
Proof of submission: confirmation page, fax receipt, certified-mail receipt, or call reference number
Official New York TBI Waiver sources
CMS currently identifies waiver 0269.R05.00 as approved from September 1, 2022 through August 31, 2027. Confirm current status on the CMS page before relying on it.
What ABI Resources is—and is not—doing here
ABI Resources provides Connecticut home and community services. This page offers national educational navigation to official government sources. ABI Resources is not the New York State government, OTDA, CMS, a New York TBI Waiver provider, a brain-injury association, or a law firm. It does not decide eligibility, hearings, aid continuing, service hours, or legal rights.
Source review date: September 18, 2026. Government rules, forms, contacts, and waiver approvals can change. Always compare this guide with the current written notice and linked official sources.
