9002 ELIGIBILITY REQUIREMENTS

9002.1 To receive IFS Waiver services a person shall be currently receiving services from the Department on Disability Services/Developmental Disabilities Administration (DDS/DDA) and meet all of the following requirements:

1. (a) Have a special income level up to three hundred percent (300%) of the Supplemental Security Income (SSI) federal benefit or be aged and disabled with income up to one hundred percent (100%) of the federal poverty level or be medically needy as set forth in 42 C.F.R. §§ 435.320, 435.322, 435.324, or 435.330;
2. (b) Have a developmental disability or an intellectual disability as defined in Section 9099;
3. (c) Be eighteen (18) years of age or older;
4. (d) Be a resident of the District of Columbia as defined in D.C. Official Code § 7-1301.03(22);
5. (e) Have a Level of Care (LOC) determination that the person requires services furnished in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) or be a person with related conditions pursuant to the criteria set forth in § 9002.4; and
6. (f) Meet all other eligibility criteria applicable to Medicaid recipients including citizenship and alienage requirements.

9002.2 Waiver services shall not be furnished to a person who is an inpatient of a hospital, ICF/IID, or nursing facility.

9002.3 Each person enrolled in the Waiver shall be re-certified annually as having met all of the eligibility requirements as set forth in § 9002.1 for continued participation in the Waiver.

9002.4 A person shall meet the LOC determination set forth in § 9002.1(e) if one of the following criteria has been met, taking into consideration the standard error of measurement for the intelligence quotient (IQ) test:

1. (a) The person's primary disability is an intellectual disability with an IQ of fifty-nine (59) or less; or
2. (b) The person's primary disability is an intellectual disability with an IQ of sixty (60) to seventy (70), and the person has at least one (1) of the following

conditions:

(1) Mobility deficits;

(2) Sensory deficits;

(3) Chronic health needs;

(4) Behavioral challenges;

(5) Autism;

(6) Cerebral Palsy;

(7) Epilepsy; or

(8) Spina Bifida; or

(c) The person's primary disability is an intellectual disability with an IQ of sixty (60) to seventy (70), or the person has a developmental disability, either of which results in substantial functional limitations in at least three (3) of the following major life activities:

(1) Self-Care;

(2) Understanding and use of language;

(3) Functional academics;

(4) Social skills;

(5) Mobility;

(6) Self-direction;

(7) Capacity for independent living; or

(8) Health and safety.

SOURCE: Final Rulemaking published at 69 DCR 010229 (August 12, 2022); as amended by Final Rulemaking published at 71 DCR 010475 (August 23, 2024).