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Developmental Disabilities Home > Eligibility

Eligibility

A determination of eligibility is a determination that a person meets the definition of a developmental disability as defined in Washington State law. An individual must meet the eligibility definition to become a DDD client.

DDD services are dependent on availability of funding and/or eligibility for the specific service. Service eligibility will be determined after an assessment is completed. Access to Medicaid State Plan services and Home and Community Based Waiver services are not limited by availability of funding.

Pencil illustration by Martha Perkse of an adult woman helping a young girl to drink from a cup.

What is a developmental disability as defined by law?

Under RCW71A.10.020(3) the definition in law of a developmental disability is:

A disability attributable to:

  • Intellectual Disability;
  • Cerebral Palsy;
  • Epilepsy;
  • Autism; or

Another neurological or other condition closely related to intellectual disability or that requires treatment similar to that required for individuals with intellectual disabilities.

 

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Which:

  • Originated before the individual attained age eighteen;
  • Continued or can be expected to continue indefinitely, and
  • Results in substantial limitations to an individual's intellectual and/or adaptive functioning.
Eligible Conditions Specific to Age (WAC 388-823-0800)
Eligible Conditions 0-5 6-9 10-17 18+
Developmental Delays X X    
Down Syndrome X X    
Too severe to be assessed X X    
Medically Intensive Children's Program X X X  
Intellectual Disability (ID)   X X X
Cerebral Palsy   X X X
Epilepsy   X X X
Autism   X X X
Another Neurological Condition   X X X
Other condition similar to ID   X X X

How is service eligibility determined?

The criteria for eligibility are defined in state law (Chapter 388-823 WAC effective July 5, 2005).

  • Applying for a determination of eligibility
    • WAC 388-823-0010 through 388-823-0170
  • Determination of a developmental disability
    • WAC 388-823-0200 through WAC 388-823-0710
  • Effect of age on eligibility
    • WAC 388-823-0800 through 388-823-0850
  • Inventory for Client and Agency Planning (ICAP)
    • WAC 388-823-0900 through 388-823-0940
  • Eligibility expiration, reviews, and application
    • WAC 388-823-1000 through 388-823-1090
  • Client rights and complaint procedures
    • WAC 388-823-1095 and WAC 388-823-110
Required Documentation for DDD Eligibility Determination (for persons age six years and older)
Disability Condition Diagnosis Diagnostician Other Evidence
Intellectual Disability Intellectual Disability or Down Syndrome Licensed Psychologist or Certified School Psychologist; Licensed Physician Psychological assessment and Full Scale (FS) IQ score
Cerebral Palsy Cerebral Palsy, Quadriplegia, Hemiplegia, Diplegia Licensed Physician Onset prior to age 3;
Assessments with information about the need for physical assistance with toileting, bathing, eating, dressing, mobility or communication
Epilepsy Epilepsy or seizure disorder Board Certified Neurologist Diagnosis based on medical history and neurological testing;
Confirmation from physician or neurologist of uncontrolled and ongoing or recurring seizures
Autism Autism or Autistic Disorder;
Per 299.00 in DSM-IV-TR		 Board Eligible Neurologist; Board Eligible Psychiatrist; Licensed Psychologist; Board Certified Developmental and Behavioral Pediatrician DSM IV diagnostic criteria; Evidence of delay or abnormal functioning prior to age 3 in social, language, communication skills, or symbolic or imaginative play
Another Neurological Condition Central nervous system impairment Licensed physician Full Scale (FS) IQ score; Assessments with information about the need for physical assistance with toileting, bathing, eating, dressing, mobility, or communication
Other Condition A condition or disorder that by definition results in both intellectual and adaptive skills deficits, and is due to a neurological condition, central nervous system disorder, or chromosomal disorder Licensed Physician or Licensed Psychologist Full Score (FS) IQ score; Evidence of academic delays
Medically Intensive (only through age 17) Not applicable Not applicable Eligibility for DSHS Medically Intensive Children's Program

How do I apply for a determination of DDD eligibility to become a DDD Client?

To apply for a determination of DDD eligibility, you will find detailed instructions and the forms you need in the Eligibility Application Packet below. Or, you can contact your local DDD office and ask for an application. If you call for an application, some information will be taken over the phone. The application and additional information and forms will be mailed to you for completion and/or signature. You will be asked to provide any available school or medical records or sources of information that will assist in determining eligibility. Copies of other documents may be required. Upon request, DDD staff can assist you with completing the application. Please be aware that eligibility cannot be determined until DDD receives your signed application and all of the necessary information.

 

Eligibility Application Packet

How do I reapply for a DDD eligibility determination?

Families must reapply for eligibility before a child reaches his/her 4th and 10th birthdays. DDD will notify you at least 90 days before the expiration date and will send reapplication information. The following table shows reviews and expiration dates.

 

 

Regardless of Date of Eligibility Determination
Age Eligibility Conditions Expiration Criteria Review Criteria
4th birthday All Termination/expiration effective 4th birthday None
10th birthday Developmental delay, Down Syndrome, Too severe to be assessed, Medically Intensive Termination/expiration effective 10th birthday None
At any age up to age 18 Medically Intensive None No longer eligible for continuous nursing through Medically Intensive Program
Age 17 - 18 All None Review begins at age 17 with termination no sooner than 18th birthday
Age 18 or older All None Prior to initial authorization of paid services if most current eligibility determination is more than 2 years old and you are not receiving paid services
At any age All None Evidence was insufficient, in error, or fraudulent; or new information becomes available

 

Eligibility Determined Before July 2005
Age Eligibility Conditions Expiration Criteria Review Criteria
Age 4 through 17 Developmental Delay, Down syndrome None Prior to initiation of paid services if you are not receiving paid services
Age 10 or older Developmental Delay, Down syndrome None Can be reviewed at any time

 

Required Evidence of Substantial Limitation
Diagnosis FS IQ Direct Physical Assistance Needs Adaptive Limitations
Developmental delay per assessment     Developmental delays
Down syndrome      
Diagnosis of a condition too severe to complete evaluation or assessment      
Eligible for Medically Intensive Children’s Program      
Intellectual Disability (ID) or Down syndrome Yes   Must be included in diagnostic assessment
Cerebral Palsy, Quadriplegia, Hemiplegia, Diplegia   Yes  
Epilepsy, Seizure Disorder   Yes (during or following seizures) * Yes
Autism, Autistic Disorder     * Yes
Impairment of the Central Nervous System Yes Yes  
Condition or disorder that by definition results in cognitive and adaptive deficits Yes or academic delays   * Yes

* Vineland, SIB-R, or ABAS-II or ICAP by DDD

If you need additional information please contact us.

Artwork reprinted by permission of Martha Perske from PERSKE: PENCIL PORTRAITS 1971-1990 (Nashville: Abingdon Press, 1998).

Last updated: March 15, 2013 | Privacy Notice

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