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The Medicaid Program has special provisions for people with developmental disabilities (DD). If you would like to apply for developmental disability services, first you need to complete a Medicaid application and be determined financially eligible for Medicaid. Then you will need to complete an application and assessment for the DD program to determine if you will be eligible for DD services.
In addition to financial eligibility, you must also meet medical disability criteria in order to be eligible for DD services. To meet medical disability criteria, your disability must:
Be chronic
Appear before the age of twenty-two (22)
Be caused by impairments such as intellectual disability, cerebral palsy, epilepsy, autism, or another condition found to be closely related to, or similar to one of these impairments that requires similar treatment or services; or be caused by dyslexia resulting from one or more of the above described impairments; and
Substantially limit your ability to function in at least three (3) of the following major life activities;
Self care
Receptive and expressive language
Learning
Mobility
Self direction
Capacity of independent living
Economic self-sufficiency
Reflect the need for a combination and sequence of special, interdisciplinary, or generic care, treatment or other services
Require services which are of lifelong or extended duration
Require services that must be individually planned and coordinated
Step 1:
You may apply for Developmental Disability (DD) services by submitting an Eligibility Application for Adults with Developmental Disabilities to your local Bureau of Developmental Disability Services (BDDS) office. An application can be mailed to you, or you
may print off a copy of the application from:
https://healthandwelfare.idaho.gov/services-programs/medicaid-health/apply-adult-developmental-disabilities-programs.
When an application is submitted, BDDS staff first verify your financial eligibility for Medicaid. If you do not currently have Enhanced Medicaid, you are still encouraged to apply as you may be eligible for Enhanced Medicaid if you meet level of care eligibility for the DD Waiver and financial criteria.
Step 2:
The IAC will review your documents to see if they have enough information to set up an assessment. If so, they will contact you, your guardian, or other representative to set up an appointment to meet with them for an interview. If not, they will send you a letter that lets you know what else is needed.
Step 3:
It is important that you are available for your scheduled interview. Make sure you ask your guardian, a friend, or another person that knows you very well to be present at the interview.
Step 4:
At the time of your interview:
• The IAC will interview you and the person you bring with you and ask about you and your needs.
• The IAC will complete the Scales of Independent Behavior—Revised (SIB-R) assessment tool with a person who knows you very well.
• The IAC may request signatures on Release of Information forms to gather more information about your disability.
• The IAC will conduct a needs inventory that will help the IAC to calculate your annual budget if you qualify for adult DD services.
• The IAC will have already provided you with an Adult DD Medical Care Form that you can take to your doctor to fill out and return. After the interview, the IAC will review the information and determine if you’re eligible for DD services. A notice will be sent to you about the results. If you are determined eligible for State Plan only services, you can choose from:
• Service Coordination; and
• Developmental Disability Agency (DDA) services If you are determined ICF/ID Level of Care eligible, you can choose from both State Plan services and DD Waiver services. DD Waiver services include:
• Residential Habilitation (Certified Family Home or Supported Living)
• Chore Services
• Respite
• Supported Employment
• Transportation
• Environmental Accessibility Adaptations
• Specialized Equipment and Supplies
• Personal Emergency Response System
• Home Delivered Meals
• Skilled Nursing
• Behavior Consultation or Crisis Management
• Adult Day Health If you are determined ICF/ID Level of Care eligible, you can choose the Consumer Directed Services option to self-direct your services instead of the services listed above.
Step 5:
If you are determined eligible for DD and/or DD Waiver services, the eligibility notice will include the amount of your annual budget and a timeline for submission of a plan. If you are determined not eligible for either one of these services, you can request an appeal hearing of this decision by submitting an appeal request to Medicaid Appeals. Information about submitting an appeal is included on the denial notice.
IMPORTANT: The assessment process must be completed EACH YEAR if you wish to continue to receive services.
Step 6:
You will need to choose a Plan Developer/Support Broker. The IAC can provide you with a list of Service Coordination Agencies if you need help finding a Plan Developer. If you decide to access State Plan and Traditional waiver services, you will use a Plan Developer to help you write your plan. Once you have selected a Plan Developer you will need to fill out the Plan Developer Choice Form and submit it to the IAC. If you decide to self-direct your services through the Consumer Directed Services option, you will use a Support Broker to help you write your plan.
For a list of Plan Developers or Support Brokers, go to:
• Plan Developers: https://healthandwelfare.idaho.gov/services-programs/medicaid-health/traditional-support-services
• Support Brokers: https://healthandwelfare.idaho.gov/services-programs/medicaid-health/self-directed-services
Step 7:
Once you have chosen a Plan Developer/Support Broker, they will help you to identify family and/or other individuals who are important to you to be part of a person-centered planning team.
Step 8:
You and your person-centered planning team will work together to evaluate your needs and goals and help you to develop a plan. For individuals who choose to access State Plan and Traditional waiver services, this plan is called an Individual Support Plan (ISP). For individuals who choose to self-direct their services, this plan is called a Support and Spending Plan (SSP). Once the plan is written, it is submitted to the Bureau of Developmental Disability Services (BDDS) for review. A Care Manager in the BDDS office will be responsible for reviewing your plan.
Step 9:
The Care Manager will make sure your plan meets your assessed needs, allows for your health and safety and is within your budget. You and your Plan Developer/Support Broker will be notified by mail if you plan has been approved.
• If the plan does not meet your assessed needs, allow for your health and safety, and/or is over budget, the Care Manager will contact your Plan Developer/Support Broker to discuss the plan. If adjustments are made to your plan so it meets your needs and is within budget, the Care Manager will be able to authorize the services on the plan.
• However, if your Plan Developer/Support Broker and the Care Manager are not able to agree on the services needed to meet your needs and/or the plan cost continues to exceed your calculated budget, the Care Manager will do one of the following:
1. Authorize some of the services on your plan; or
2. Deny all of the services on your plan. The Care Manager will send a Notice to you, your Plan Developer/Support Broker and your guardian (if applicable) to let you know what services were approved and/or denied. If you don’t agree with the Care Manager’s decision to deny some or all of your services, you can request an appeal through Medicaid Appeals. Information about submitting an appeal is included on the notice.
Step 10:
If some or all services on your plan are approved, these services will be authorized in the Medicaid payment system. If you are accessing Traditional DD services, the providers listed on your plan will also be notified they can provide services and the date you can begin receiving those services. If you are self-directing your services, you will need to notify your community support workers when they can begin to provide services.
Step 11:
If your plan needs to be changed during the plan year, this can be done by your Plan Developer/Support Broker. For State plan or traditional waiver services, a Plan Developer will complete an addendum and provide any documents that support the requested changes. For self-directed services, a Support Broker will do a Plan Change Form. An update to a plan must be submitted in the following circumstances: For a State Plan or Traditional waiver plan:
• A change in provider
• A change in the amount of time you will be receiving a service
• Adding or deleting a service For a Self-Directed plan:
• Adding or deleting services in a support category
• Moving money from one support category to another
If you are currently receiving children’s DD services through DHW’s children’s DD program and would like to transition into the adult DD program, there are a few resources to help you along the way.
Contact the Children’s Developmental Disabilities program and ask about trainings for transitioning to adult services
Transition from children’s services guide
Differences between consumer-directed services for children and adults
