Disability Determination - Non Sequential Evaluation Process (SEP) Approvals

Revised on: April 24, 2026

WAC 388-449-0001 What are the disability requirements for the Aged, Blind, or Disabled (ABD) program?

Clarifying Information

The Disability Specialist reviews available records and approves ABD when the client meets any non-SEP criteria outlined in WAC 388-449-0001. Non-SEP approval criteria include when the client:
1. Has an existing ABD approval that hasn’t ended and can be reopened;
  1. If a client has been closed on ABD with at least 30 days left of their 24-month disability period, they can be reapproved until the end of their current disability period if they meet all other eligibility requirements.
2. Is determined blind or disabled by the Social Security Administration (SSA);
3. Is determined disabled by the Division of Disability Determination Services (DDDS) for Non-Grant Medical Assistance with current date of eligibility or reexamination waived;
4. Has had their Supplemental Security Income (SSI) payment stopped because they are not a citizen;
5. Is eligible for long-term care services from the Home and Community Living Administration (HCLA) for a medical condition that is expected to last twelve months or more or result in death;
6. Is functionally eligible for services from Developmental Disabilities Community Services (DDCS); or
7. Has been diagnosed as having an intellectual disability based on a full scale score of 70 or lower on the Wechsler adult intelligence scale (WAIS)

Worker Responsibilities

To determine if client meets non-SEP criteria for DDCS services, NGMA determination or is eligible for long-term care services, staff should review the following:

DDCS

Type	Description
DDCS DSHS 15-345 form	The 15-345 (indexed as 345 in Barcode) is the communication form DDCS Social Services staff use to notify DDCS financial staff of a client’s program eligibility. This form indicates that a client is eligible for waiver services. It includes service(s) and date they began.
Worker of record on the client screen in Barcode.	If a client is receiving DDCS services, the office code 17 will follow the financial worker of record. Example: Financial- Mouse, Minnie (17)
ACES case narrative	Look for a statement regarding DDCS eligibility. Example: Client approved for 23 hours/month for personal care services.
Open L track medical	L track medical is an indicator that someone may be receiving DDCS services. It is also used by HCS. Review documents in Barcode and the document assignment to determine which division approved the medical program. If client was approved for HCS services, see section below for guidance. Note: The Apple Health manual provides an overview of programs listed here Overview: long-term services and supports program administration chart \| Washington State Health Care Authority

Note: If a client is functionally eligible for DDCS services, they meet non-SEP criteria. To qualify for DDCS services someone must have a condition (listed in WAC 388-823-0015 ) that started before age 18, expected to continue indefinitely, and results in substantial limitations which meets the definition in WAC 388-449-0001 for a condition lasting at least 12 months or expected to result in death.

NGMA

Type

Description

DSHS 14-144 (ODI).

This form is used by eligibility staff to notify DDDS that a client needs a NGMA determination or redetermination.

When this form is in the ECR, it is an indication to look for the “State of Washington Disability Transmittal Sheet” for an ODI determination.

“State of Washington Disability Transmittal Sheet” (ODI) [Document does not have a DSHS form # on it].

This is the NGMA determination decision form. It will indicate whether a client was approved or denied the NGMA.

If approved, client meets non-SEP criteria.

HCS Long-Term Care

Type	Description
CARE Assessment (CAR)	A CARE Assessment is conducted to evaluate a person’s ability to care for themselves. It is used to determine eligibility for HCS long-term care programs. The assessment focuses on functional limitations and activities of daily living, not condition duration. Duration is not listed on the CARE assessment. Disability Specialists determine duration of the client’s medical condition by reviewing the CARE assessment, other documents from HCS, and any supporting medical records in the ECR . When reviewing records look for diagnosis, services provided, hours, level of care, and/or any past assessments. Consider other factors that may impact duration such as co-morbidities, age, underlying health conditions, etc. If unable to determine duration based on documents reviewed, consult the HCS worker listed on the CARE assessment for clarification. If duration is still unclear, request additional medical evidence and complete the SEP. Document in ICMS notes what medical evidence was used. Include diagnosis and how duration was determined.
CARE Service Summary (CAR)	It may not be clear if someone was approved on a condition that will last 12 months or result in death because eligibility is based on functional abilities (not condition duration). For example, the ability to complete activities of daily living independently (meal prep, hygiene, medication management, shopping, etc). See above for information regarding determining duration.
HCS DSHS 14-443 form	The 14-443 (indexed as 443 in Barcode) is the communication form HCS Social Services staff use to notify HCS financial staff of a client’s program eligibility. This form indicates that a client was approved for services and to review HCS documentation or contact the HCS worker to determine if client meets non-SEP criteria.

Note: Medical evidence is needed to determine if a new or worsening condition exists when a client was previously approved ABD through non-SEP criteria and was subsequently denied SSI/SSDI by SSA. When processing a case for a new or worsening condition, staff will select “no” to the long-term care or NGMA indication box to continue with the SEP screens in ICMS.

Related Procedures (Staff Only)

ABD Referrals