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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:

  • Mental Retardation;
  • Cerebral Palsy;
  • Epilepsy;
  • Autism; or
  • Another neurological or other condition closely related to mental retardation or that requires treatment similar to that required for individuals with mental retardation.
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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.

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

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

 

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: August 17, 2009 | Privacy Notice

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