OMIG Town Hall

On March 21st, we hosted a Town Hall with the Office of the Medicaid Inspector General (OMIG) and had an informative discussion among FIs, parents, advocates, and providers surrounding the role of OMIG as it relates to OPWDD and the Self-Direction Community Class program.

At the C4SD Town Hall, OMIG Clarified a critical point: OPWDD sets the policies. OMIG's role is to assess compliance with those policies. Our advocacy must be directed accordingly. Additionally, we came away from the event with three other key takeaways:

• There have been no audits of Community Classes. OMIG Has not yet developed a protocol for this. 

• OMIG pledged to work with our advocacy community as these protocols are developed.

• Until clear protocols exist, the safest approach for FIs is to document compliance with official written guidance from their Oversight Agency, OPWDD. (See note below.*)

To view the full recording of the Town Hall, an abridged “highlight reel,” and to download OMIG’s presentation, click the icons to the left.

C4SD will organize a follow-up Town Hall. At that event, we hope to examine real—not hypothetical—cases in light of official written documentation. FIs are invited to submit anonymized "gray area" cases for review. Please send these to info@coalition4sdf.org with the subject link: "Non-Hypothetical Case."

C4SD is committed to working creatively and collaboratively to protect Self-Direction. We appreciate OMIG's willingness to clarify important points, and we look forward to continued engagement and advocacy to ensure the flexibility and integrity of Self-Direction for all. 

* Note on Official Written Guidance: A Safe Harbor for FIs? 
An objective standard for determining whether a particular thing is official guidance is: Does it hold up in Fair Hearings and court? To date, no judge or administrative law judge has ruled on the validity of the "red flags" raised in OPWDD's November 2022 training. That is because OPWDD has never submitted them as evidence, despite multiple opportunities. This speaks volumes. 

FIs would be wise to maintain records of past Fair Hearings and court cases involving Community Classes. Every time these cases have been adjudicated, the only criteria submitted by OPWDD have been official written guidance, statutes, and regulations. At our next Town Hall, we hope to get closer to clarity (and further away from fear). In the meantime, FIs can download and reference these two key decisions: 

• Fair Hearing Case (April 2024)

• Article 78 Court Case