9002 ELIGIBILITY REQUIREMENTS

9002.1 In order to receive Waiver services a person shall be currently receiving services from DDS/DDA and meet all of the following requirements:

1. (a) Have a special income level up to three hundred percent (300%) of the 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 and 435.330;
2. (b) Have an intellectual disability as defined in D.C. Official Code § 7-1301.03(15A), which, when establishing qualifying intelligence quotient (IQ), includes consideration of the standard error of measurement associated with the particular IQ test, and requires adaptive deficits across at least two (2) of the following three (3) domains: conceptual, practical, and social;
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 IQ test:

1. (a) The person's primary disability is an intellectual disability with an intelligence quotient (IQ) of fifty-nine (59) or less;

(b) The person's primary disability is an intellectual disability with an IQ of sixty (60) to sixty-nine (69) and the person has at least one (1) of the following additional conditions:

(1) Mobility deficits;

(2) Sensory deficits;

(3) Chronic health problems;

(4) Behavior problems;

(5) Autism;

(6) Cerebral Palsy;

(7) Epilepsy; or

(8) Spina Bifida.

(c) The person's primary disability is an intellectual disability with an IQ of sixty (60) to sixty-nine (69) and the person has severe 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.

(d) The person has an intellectual disability, has severe functional limitations in at least three (3) of the major life activities as set forth in § 9002.4(c)(1) through § 9002.4(c)(8), and has one (1) of the following diagnoses:

(1) Autism;

(2) Cerebral Palsy;

(3) Prader Willi; or

(4) Spina Bifida.

SOURCE: Final Rulemaking published at 69 DCR 010229 (August 12, 2022).