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Waiver

Title XIX I/DD Waiver: Eligibility Criteria



To be eligible for the Title XIX I/DD Waiver program an individual must satisfy the requirements for medical and financial eligibility. The guidelines for eligibility, both medical and financial, are outlined below.


Medical Eligibility:

Applicants must meet the medical eligibility criteria in each of the following categories:

Diagnosis:
The applicant must have a diagnosis of mental retardation with concurrent substantial deficits manifested prior to age 22 or a related condition which constitutes a severe and chronic disability with concurrent substantial deficits manifested prior to age 22.

Examples of related conditions which, if severe and chronic in nature, may an individual eligible for the I/DD Waiver Program include, but are not limited to, the following:
  • Autism
  • Traumatic Brain Injury
  • Cerebral Palsy
  • Spina Bifida
  • Any condition, other than mental illness, found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons, and requires services similar to those required for persons with mental retardation.

Functionality:
The applicant must present with at least 3 substantial deficits out of the 6 identified major life areas:
  • Self-care
  • Receptive or expressive language (communication)
  • Learning (functional academics)
  • Mobility
  • Self-direction
  • Capacity for independent living which includes the following 6 sub-domains: home living, social skills, employment,health and safety, community and leisure activities. At a minimum, at least 3 of these sub-domains must be substantially limited in order to meet the criteria in this major life area.

Active Treatment:
Documentation must support that the applicant would benefit from continuous active treatment. Active treatment includes aggressive consistent implementation of a program of specialized and generic training, treatment, health services and related services.

Active treatment does not include services to maintain generally independent individuals who are able to function with little supervision or in the absence of a continuous active treatment program.


Financial Eligibility: (determined by the county DHHR office of the person's residence)


Income:
The individual's monthly income may not exceed 300% of the current maximum Supplemental Security Income (SSI). The parent's income is not considered in determining financial eligibility. An individual does not have to be SSI eligible to become eligible for the I/DD Waiver Program.

Assets:
An individual's assets may not exceed $2,000. The parent's assets are not considered when determining eligibility.

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