How to Set Up a Supported Decision-Making Agreement in New York

What a Supported Decision-Making Agreement Actually Does

A Supported Decision-Making Agreement lets an adult with an intellectual or developmental disability choose trusted people — called supporters — to help them understand information, think through options, and communicate decisions. The critical distinction: supporters assist, but the individual makes the final call. No legal rights are transferred. No court is involved.

New York formalized this framework under Mental Hygiene Law Article 82, with implementing regulations under 14 NYCRR Part 634 that became effective on August 20, 2025. Once properly executed, a New York SDMA carries legal weight — third parties like banks, hospitals, and service providers must honor decisions made with supporter assistance and cannot refuse to deal with the individual because they use an SDMA.

For families approaching the 18th birthday transition, an SDMA is often the first tool to evaluate before considering guardianship or a representative payee appointment.

The Six Legal Requirements for a Valid SDMA

Under MHL Section 82.10, a Supported Decision-Making Agreement must meet all six requirements to be legally enforceable:

1. Written, dated, and signed by the decision-maker and every named supporter.
2. Lists the specific categories of decisions where support is authorized — for example, healthcare, finances, housing, employment, or education.
3. Details the exact types of support each supporter is permitted to provide — such as explaining medical information, helping compare housing options, or accompanying the individual to meetings.
4. Contains an attestation from each supporter that they will honor the individual's autonomy and will not exert undue influence or make decisions for them.
5. Signed by an authorized facilitator or educator, certifying that the agreement was developed through a recognized facilitation process.
6. Executed in the presence of at least two adult witnesses or a notary public.

Missing any of these elements means the agreement may not be recognized by third parties, even though MHL Article 82 is fully enacted.

Step-by-Step: Creating Your SDMA

Step 1: Identify supporters. The decision-maker chooses who they trust. Supporters can be parents, siblings, friends, teachers, or service providers. You can name different supporters for different decision areas — one person for medical decisions, another for financial matters. There is no limit on the number of supporters.

Step 2: Define the scope. Work together to identify which categories of decisions need support and what kind of help is needed. Be specific. "Help me understand my medical options" is enforceable. A vague grant of authority is not.

Step 3: Contact an authorized facilitator. This is the step that catches many families off guard. Under 14 NYCRR Part 634, the agreement must be developed through a facilitation process conducted by an authorized facilitator or educator. AIM Services Inc. operates as the designated statewide coordinator of SDM Facilitation under OPWDD oversight. Contact them to find a trained facilitator in your area.

The facilitator guides the decision-maker through a structured conversation about their preferences, strengths, and support needs. This is not a legal proceeding — it is a collaborative planning session designed to ensure the agreement genuinely reflects the decision-maker's choices.

Step 4: Draft the agreement. The facilitator helps produce the written agreement using the statutory form requirements. The document must include all six elements listed above.

Step 5: Execute the agreement. The decision-maker, all named supporters, and the facilitator sign the document in front of two adult witnesses or a notary public.

Step 6: Distribute copies. Give copies to every third party who needs to recognize the SDMA — the individual's doctor, bank, school, CCO care manager, and any service provider who may need to communicate with the supporters.

What Happens When a Third Party Refuses

Under MHL Article 82, third parties cannot discriminate against an individual solely because they use a Supported Decision-Making Agreement. A bank that refuses to let the individual open an account with supporter assistance, or a hospital that insists on speaking only to a guardian, is violating the statute.

In practice, some third parties are still unfamiliar with SDMAs. Carrying a clean copy of the executed agreement — along with a brief cover letter citing MHL Article 82 and 14 NYCRR Part 634 — typically resolves resistance. If a third party still refuses, the individual or their supporters can file a complaint with the relevant oversight body.

When SDM Is Not Enough

An SDMA works when the individual can participate meaningfully in decisions, even if they need significant support to do so. It does not work when the individual cannot express preferences, cannot understand basic concepts even with explanation, or is vulnerable to exploitation that supporters cannot prevent.

In those cases, families may need to pursue Article 17-A or Article 81 guardianship. Many families also combine an SDMA with other targeted tools — a healthcare proxy for medical emergencies, a representative payee for SSI management — to cover specific gaps without resorting to full guardianship.

Building the Complete Decision-Making Plan

The New York SSI at 18 & Adult Disability Benefits Guide includes a decision-making comparison worksheet that walks through each option — SDMA, representative payee, healthcare proxy, Article 17-A, and Article 81 — with the specific criteria, costs, and steps for each, so you can match the right tool to your family's situation.

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