New York offers a range of federal and state benefits for people with Down Syndrome, including SSI, SSDI, Medicaid waivers, and ABLE accounts. This guide explains eligibility, how to apply, and where to get help—tailored for New York residents.
To qualify for federal disability benefits like SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance), you must meet the Social Security Administration’s (SSA) definition of disability, which includes a physical or mental impairment that prevents substantial work and is expected to last at least one year or result in death. For SSI, there are strict income and resource limits. For SSDI, you or a parent must have a sufficient work history and paid into Social Security. Children under 18 with disabilities usually qualify based on family income for SSI. Adults with disabilities that began before age 22 may qualify for SSDI as a Disabled Adult Child (DAC) if a parent is receiving retirement or disability benefits or is deceased[4].
For Medicaid, federal rules require low income and limited resources, but states like New York have expanded eligibility options, including waivers for home and community-based services (HCBS).
New York State uses federal rules for SSI and SSDI but offers extra support through Medicaid waivers, state-funded programs, and accessible application help. The state does not have its own disability payroll insurance like California, but its Medicaid program (including HCBS waivers) can cover services like respite care, therapies, and supports for daily living for people with Down Syndrome. New York also has its own ABLE program, enabling tax-advantaged savings without affecting SSI or Medicaid eligibility. For families, children with Down Syndrome may qualify for Medicaid regardless of parental income through the Children’s Health Insurance Program (CHIP) or waiver programs. Adults should check both SSI/SSDI and Medicaid waiver criteria, as these programs often work together to provide comprehensive support.
SSI/SSDI Application Steps:
Medicaid & HCBS Waiver Application Steps:
ABLE Account Setup:
SSI (Supplemental Security Income): Provides monthly cash assistance to low-income individuals with disabilities, including children and adults with Down Syndrome. SSI is needs-based and has strict income and resource limits.
SSDI (Social Security Disability Insurance): Offers benefits to adults who have worked and paid into Social Security, and to adults disabled since childhood (DAC benefits) based on a parent’s work record. SSDI is not needs-based but requires a qualifying work history.
Medicare: Available to SSDI recipients after a 24-month waiting period. Covers hospital, medical, and prescription drug costs.
Medicaid: A joint federal-state program offering health coverage to low-income individuals, including those with disabilities. Medicaid can cover services beyond what Medicare offers, such as long-term supports.
ABLE Accounts: Federally authorized savings accounts for people with disabilities. Funds do not count toward SSI or Medicaid resource limits.
New York Medicaid: The state’s Medicaid program covers a wide range of services, including doctor visits, therapies, and medical equipment. New York has expanded eligibility, so more families with children who have Down Syndrome can qualify, regardless of income in some cases.
HCBS Waivers: New York offers several Medicaid Home and Community-Based Services (HCBS) waivers, such as the Care at Home Waiver, which can fund respite care, habilitation, and other supports for people with developmental disabilities, including Down Syndrome. These waivers help keep individuals in their homes and communities instead of institutions.
New York ABLE Program: Lets residents with disabilities save up to $100,000 without affecting SSI eligibility. Funds can be used for education, housing, transportation, and other qualified expenses.
Developmental Disabilities Services Office (DDSO): Oversees services and supports for New Yorkers with developmental disabilities. Local DDSO offices can help with applications, care planning, and accessing community resources.
New York State Office for People With Developmental Disabilities (OPWDD): Provides coordination, resources, and advocacy for people with developmental disabilities and their families. OPWDD manages waiver programs and can help connect you to local services.
New York’s ABLE account program allows individuals with disabilities to save and invest money without losing eligibility for SSI, Medicaid, or other benefits. You can contribute up to the federal gift tax limit annually (as of 2025). Funds must be used for qualified disability expenses, such as education, housing, transportation, and health care.
SSI has strict income and resource limits ($2,000 for an individual, $3,000 for a couple in 2025). Some income is not counted, such as the first $20 of most income received in a month. Medicaid income limits vary by program and household size—some waivers have higher limits or no parental income limits for children. SSDI does not have income or resource limits, but earnings above certain levels can affect eligibility for DAC benefits.
If you receive more benefits than you’re entitled to, you must repay the overpayment. Report any changes in income, living situation, or resources to Social Security and Medicaid promptly to avoid overpayments and penalties. The SSA and New York Medicaid have procedures for disputing overpayments or requesting waivers.
New York’s HCBS waivers can fund supports like respite care, therapies, and personal care for people with Down Syndrome. Waivers help individuals live at home and participate in their communities, rather than in institutions. Connecting with OPWDD early can help you access these vital resources sooner.
When your child with Down Syndrome turns 18, they must reapply for SSI as an adult. If they qualify as a Disabled Adult Child (DAC), they may receive benefits based on a parent’s Social Security record. Planning ahead with your local Social Security office and OPWDD can make this transition smoother.
Yes, if your family meets the income and resource limits. Children with Down Syndrome often qualify based on medical criteria and family financial need. The amount your child receives depends on your household income and living situation.
SSI is needs-based for low-income individuals with disabilities. SSDI is based on work credits and is available to those who have worked enough to qualify or to adults disabled since childhood (DAC) if a parent is eligible for Social Security.
Apply for Medicaid through the NY State of Health Marketplace. For waivers, contact your regional Developmental Disabilities Services Office or OPWDD to request an assessment and application.
Yes, using a New York ABLE account. Funds in the account do not count toward SSI or Medicaid resource limits, up to $100,000.
At 18, your child must reapply for SSI as an adult. If the disability began before age 22, your child may qualify for DAC benefits if you are receiving Social Security retirement or disability benefits.
Yes, both programs offer work incentives. You can find more information in our <a href="/guides/work-incentives">SSI & SSDI Work Incentives</a> guide.
This guide is for informational purposes only and is not legal or financial advice. Always consult with a qualified professional for personalized guidance.
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Waivers can cover respite care, therapies, habilitation, adaptive equipment, and other supports not usually covered by regular Medicaid. Services vary by waiver and individual need.
Report all changes in income, living situation, or resources to the SSA and Medicaid. This includes jobs, moves, or changes in household membership.
Contact your local Social Security office, Department of Social Services, or OPWDD. Nonprofits like Disability Rights NY also provide advocacy and support.
Working may affect SSI or Medicaid eligibility depending on income. SSDI has special rules for work activity. Always check how earnings will impact your specific benefits before starting a job.
