“Needs-based” refers to meeting the eligibility and/or priority criteria that are required for that waiver’s services.

Emergency is defined as a situation in which the health and welfare of an individual is threatened, and alternative placement in a supervised group living setting is not available or is determined by the division to be an inappropriate option.

• Eligible individual in other setting whose health and welfare is threatened.
• Eligible individuals transitioning to the community from nursing facilities, extensive support needs homes, and state operated facilities.
• Eligible individuals determined to no longer need/receive active treatment in group home.
• Eligible individuals transitioning from 100% state funded services.
• Eligible individuals with loss or incapacitation of the primary caregiver.
• Eligible individuals with an aging primary caregiver.
• Eligible individuals aging out of Department of Education, Department of Child Services, or Supported Group Living.
• Emergency Placement.
• Eligible individuals requesting to leave a Large Private Intermediate Care Facilities/Intellectual Disabilities (ICFs/ID).
• Eligible individuals transitioning from Crisis Management and meet certain other criteria.

Individuals meeting the state criteria for a developmental disability and meeting the criteria for an ICF/ID level of care determination are eligible to receive waiver services. “Developmental Disability” means a severe, chronic disability of an individual.

• Is attributable to intellectual disability, cerebral palsy, epilepsy, or autism; or
• any other condition (other than a sole diagnosis of mental illness) found to be closely related to intellectual disability,
• Is manifested before the individual is twenty-two (22) years of age.
• Is likely to continue indefinitely.
• Results in substantial functional limitations in at least three (3) of the following areas of major life activities:
  • Self-care
  • Understanding and use of language
  • Learning
  • Mobility
  • Self-direction
  • Capacity for independent living

If you have been deemed ineligible as not meeting one of these criteria, you have the right to appeal the decision within 33 calendar days of the date of the notice. Instructions about this process can be found here.

DDRS realizes that many individuals currently on the Medicaid Waiver wait list have application dates for more than one waiver – possibly with different dates. A targeting letter is sent to individuals who are on a wait list for a DDRS waiver when his/her application date is being targeted. DDRS targets individuals on the DDRS Medicaid Waiver wait list in order of application date, starting with the oldest.

Moving forward, individuals will be targeted for the FSW – no matter what DDRS Medicaid waiver wait list he/she is on – by the earliest application date that he/she has submitted. For example, if you applied for the DD Waiver on January 1, 2001, and the ASD Waiver on March 3, 2001, you will be targeted for the FSW based on your January 1, 2001, application date. It is the responsibility of an individual or his/her legal guardian to contact his/her local BDDS office once a year to (1) update any changes to contact information, and (2) indicate preference for remaining on the DDRS Medicaid Waiver wait list. As long as your contact information is updated, a targeting letter will reach you upon DDRS’ targeting of your Medicaid waiver application date.

An applicant/participant must meet three of six substantial functional limitations and each of four basic conditions (listed below) in order to meet LOC.

The basic conditions are:

• intellectual disability, cerebral palsy, epilepsy, autism, or condition similar to intellectual disability,
• the condition identified above is expected to continue,
• the condition identified above had an age of onset prior to age 22, and
• the applicant needs a combination or sequence of services

The substantial functional limitation categories, as defined in 42 CFR 435.1009, are:

• self-care,
• learning,
• self direction,
• capacity for independent living,
• receptive and expressive language, and
• mobility.