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Interested in receiving Care Coordination Services?

The first step is to complete the form below. Upon receipt, we will send you an Enrollment consent packet to get you started on the process. To initiate the OPWDD Process, you must complete this form in its entirety.

Due to a high volume of referrals and enrollment requests, our current response time is approximately 4 to 6 weeks.

We understand that waiting can be difficult, and we sincerely appreciate your patience as we work to respond to everyone as quickly as possible and in the order received. If you would prefer not to wait, you may wish to explore enrollment with another Care Coordination Organization (CCO). A list of OPWDD-approved CCOs can be found on the OPWDD website.

Thank you for your patience and understanding. We look forward to connecting with you.

Person in Need of Care Management

Do you have Medicaid? *
Insurance/MCO Medicaid Managed Care Program? *
Is this person enrolled in another CCO/Agency? *
Is the person currently living in New York State? *

Address

Primary Contact or Authorized Signer

Same person as completing form? *
If the person in need of services is over 18, are they able to independently sign (Authorized Signer) their own consents? *

Person Completing Form

reCAPTCHA Checkbox *

We thank you for your interest in Care Design NY. One of our Enrollment Coordinators will connect with you as soon as possible to provide you with further information about the enrollment process. If you have additional questions, please call our central enrollment number at 518-320-8400. We look forward to working with you. Please note that all inquiries are answered in the order received, so your patience is greatly appreciated.