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Eligibility

In order to be eligible for the IFDDS Waiver, individuals should be at least five years, nine months of age and older, with a developmental disability such as Autism Spectrum Disorder, who do not have a diagnosis of an Intellectual Disability (ID), and who have been determined to require the level of care provided in an ICF/MR.

They must also meet criteria in three areas of eligibility - diagnostic, functional, and financial.

Diagnostic

An individual must have a developmental disability and not have a diagnosis of Intellectual Disability (ID) as defined by the American Association on Intellectual and Developmental Disabilities (AAIDD).

A developmental disability is defined as “a severe chronic disability that is evident before a person is 22 and is likely to continue indefinitely.” Attributes relating to this definition, other than mental illness, results in substantial functional limitation in three or more of the following areas of major life activity: self-care, understanding and use of language, learning, mobility, self-direction, and capacity for independent living. While ID is considered a developmental disability in Virginia, there is a separate waiver for persons with a diagnosis of ID.

 

Functional

The individual must meet the Intermediate Care Facility (ICF) for the Intellectual Disability (ID) level of care criteria. This is determined during the initial screening process. A representative from the local CDC goes to the home of the individual requesting services to conduct a “level of functioning survey” which will then determine if the individual is eligible for services.

Click here to see a sample LOF survey:
http://www.dbhds.virginia.gov/library/document-library/ods_level%20of%20functioning%20survey%20summary%20sheet.pdf


Financial

It is the responsibility of the Department of Social Services (DSS) to determine an individual’s financial eligibility and patient pay responsibilities for Medicaid. Medicaid policies for individuals who receive home and community-based services allow a different method of determining income and resource eligibility. Waiver recipients are allowed to have a total monthly income of 300% of SSI. For this year (2015), that amount is $2199. However, they could be responsible for a monthly patient-pay if their income is over 165% of SSI - $1209.

Based on these policies, some individuals, not otherwise eligible for Medicaid, may become eligible for enrollment into the DD Waiver and receive waiver services as well as all other Medicaid covered services when deemed medically necessary.

Prior to enrolling in the DD waiver, contact your local DSS office to apply for Medicaid. You will need to specify that you’re applying for Long-Term Care Medicaid. Under Long-Term Care Medicaid, eligibility is based SOLELY on the income of the person who will be receiving long-term care services (at home using a Medicaid Waiver or in an institution such as a nursing facility). Parents’ income is NOT included. The resource limit for adults is $2,000. The resource limit for children is $1,000. Parents’ resources and assets are NOT included.