Disability Determination - Non Sequential Evaluation Process (SEP) Approvals

 Revised on: March 3, 2026

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

Clarifying Information

  1. 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)

 

Documentation

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

DDCS

Type

Description

ACES case narrative to determine if client is eligible for DDDS services.

 

Look for a statement regarding 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 DDDS 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 by the department to inventory and evaluate a person’s ability to care for themselves. The assessment focuses on functional limitations and activities of daily living. It is used to determine eligibility for long-term care programs.  CARE assessments are reviewed every 12 months.

Review the CARE summary to determine duration of the client’s medical condition or functional limitations. If unable to determine duration in the CARE Assessment, consult the worker listed on the CARE Service Assessment for clarification.

CARE Service Summary (CAR)

The CARE Service Summary lists services clients are functionally eligible for, severity classification, and monthly hours.  

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. For example, the ability to complete activities of daily living independently. If duration is not clear, consult the worker listed on the CARE Service Summary for clarification.

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)