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Eligibility 

Applicant Eligibility and Enrollment
 

In order for an applicant to be found eligible for the IDDW Program, they must:
 

  • Meet medical eligibility;

  • Meet financial eligibility;

  • Be at least three years of age;

  • Be a resident of West Virginia, and be able to provide proof of residency upon application; and

  • Have chosen Home and Community-Based Services over services in an institutional setting           (Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).

Enrollment in the IDDW Program is dependent upon the availability of a funded IDDW slot. The applicant must have a written determination that they meet medical eligibility criteria. Initial medical eligibility is determined by the Medical Eligibility Contracted Agent (MECA) through review of an Independent Psychological Evaluation (IPE) report completed by a member of the Independent Psychologist Network (IPN); which may include: background information, mental status examination, a measure of intelligence, adaptive behavior, achievement and any other documentation deemed appropriate. If an IDDW slot is available, then the applicant must establish financial eligibility before being enrolled in the IDDW Program. If a slot is not available, the applicant is placed on a managed enrollment list. When a slot becomes available, then the applicant is informed and must establish financial eligibility before being enrolled on the IDDW Program.

Initial Medical Eligibility
 

To be medically eligible, the applicant must require the level of care and services provided in an ICF/IID as evidenced by required evaluations and other information requested by the IP or the MECA and corroborated by narrative descriptions of functioning and reported history. An ICF/IID provides services in an institutional setting for persons with intellectual disability or a related condition. An ICF/IID provides monitoring, supervision, training, and supports. Evaluations of the applicant must demonstrate:
 

  • A need for intensive instruction, services, assistance, and supervision in order to learn new skills, maintain current level of skills, and/or increase independence in activities of daily living; and
     

  • A need for the same level of care and services that is provided in an ICF/IID.
     

  • The MECA determines the qualification for an ICF/IID level of care (medical eligibility) based on the IPE that verifies that the applicant has intellectual disability 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. For the IDDW Program, individuals must meet criteria for medical eligibility not only by test scores, but also narrative descriptions contained in the documentation. In order to be eligible to receive IDDW Program Services, an applicant must meet the medical eligibility criteria in each of the following categories:

    • Diagnosis;

    • Functionality;

    • Need for active treatment; and

    • Requirement of ICF/IID Level of Care


 

Diagnosis

The applicant must have a diagnosis of intellectual disability 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 may, if severe and chronic in nature, make an individual eligible for the IDDW Program include but are not limited to, the following:

  • Autism;

  • Traumatic brain injury;

  • Cerebral Palsy;

  • Spina Bifida; and

  • Any condition, other than mental illness, found to be closely related to intellectual disabilities because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of intellectually disabled persons, and requires services similar to those required for persons with intellectual disabilities.

  • Additionally, the applicant who has a diagnosis of intellectual disability or a severe related condition with associated concurrent adaptive deficits must meet the following requirements:

  • Likely to continue indefinitely; and,

  • Must have the presence of at least three substantial deficits out of the six identified major life areas listed under Section 513.6.2.2, Functionality.
     

 

Functionality

The applicant must have substantial deficits in at least three of the six identified major life areas listed below:

  • Self-care;

  • Receptive or expressive language (communication);

  • Learning (functional academics);

  • Mobility;

  • Self-direction; and

  • Capacity for independent living which includes the following six sub-domains: home living, social skills, employment, health and safety, community and leisure activities. At a minimum, three of these sub-domains must be substantially limited to meet the criteria in this major life area. Substantial deficits are defined as standardized scores of three standard deviations below the mean or less than one percentile when derived from a normative sample that represents the general population of the United States, or the average range or equal to or below the 75th percentile when derived from ID normative populations when intellectual disability has been diagnosed and the scores are derived from a standardized measure of adaptive behavior. The scores submitted must be obtained from using an appropriate standardized test for measuring adaptive behavior that is administered and scored by an individual properly trained and credentialed to administer the test.