Federal benefits and state services
Learn what's available for adults with developmental disabilities.
(Revised: June 2016)
A variety of federal benefits and state services are established to support adults with developmental disabilities.
It can be very confusing to sort through the differences between Social Security and Medicaid benefits, as well as the many services and programs provided in this state.
To help you understand your options, this booklet offers an overview of the following major benefits and services:
Table of Contents
DIVISION OF DEVELOPMENTAL DISABILITIES STATE SERVICES AND SUPPORTS
- State Services and Supports
- Home and Community-Based Services Waivers
- New HCBS Waiver: Individial & Family Services Waiver
- What is the Community First Choice (CFC) Medicaid Program?
- Case/Resource Management (CRM)
- Community First Choice (CFC) Personal Care
- Community Residential Services (CRS)
- Non-DD Residential Services
- Employment & Day Programs
- Resource Numbers
SUPPLEMENTAL SECURITY INCOME (SSI)
SSI is a social security program that provides a monthly payment to adults with a disability and children who meet Social Security’s disability and income criteria.
SSI eligible persons are eligible for Medicaid under the Categorically Needy Program (CNP) through Washington State Department of Social and Health Services (DSHS).
Who Can Receive SSI?
Individuals who are age 65 or older or blind or have a disability. Total worth of countable assets should be less than $2,000 worth for a person, and less than $3,000 for a couple/family (combined assets as a family).
Click here for resource information.
The most reliable way to figure out all of these variables is using their screening tool referred to as BEST (Benefit Eligibility Screening Tool)
NOTE: Income rules change once the individual receives SSI.
How Much is the SSI Cash Benefit?
The basic SSI amount is the same nationwide. However, many states add money to the basic benefit. In Washington State, benefits vary by area.
Call 1-800-772-1213 or TTY 1-800-325-0778 for specific amounts.
Click here for more information.
Click here for an electronic booklet of SSI - English, Spanish and Audio version.
SOCIAL SECURITY DISABILITY INSURANCE (SSDI)
Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes. SSDI benefits are paid to people who are unable to work for a year or more because of their disability.
Who is eligible for SSDI?
You may be eligible to receive SSDI if you:
- Have worked in jobs and paid social security taxes;
- Have a significant work history, have enough “Work Credits”;
- Have a medical condition that meets Social Security’s definition of a disability and the disability must be expected to last at least one year or result in death (temporary disability or short term disability is NOT eligible).
SSDA benefits for “adults disabled since childhood (this is the term SSA uses). What it means is it is a SSDI benefit for an adult with a disability that began prior to age 22 AND must meet the definition of disability for adults. This is also known as “DAC” or “DCB” (Disabled Adult Child Benefit).
For a disabled adult to become entitled to this “child” benefit, one of his or her parents:
- Must be receiving Social Security retirement or disability benefits; or
- Must have died and have worked long enough under Social Security.
What does Social Security consider a disability for SSDI?
Disability under Social Security is based on a person’s inability to work. He/She cannot perform at the same working capacity as he/she did before, and Social Security decides that he/she cannot adjust to other work because of his/her medical condition(s). Disability must also last or be expected to last for at least one year or to result in death.
What is the Monthly SSDI Benefit?
The monthly disability benefit is based on the employee’s lifetime average earnings covered by Social Security. Call 1-800-772-1213 or click here for more information.
Click here to go straight to disability benefits.
What is Medicaid? Who is Eligible?
Medicaid is a joint federal and state entitlement administered by The Health Care Authority (HCA). The HCA is the state agency that oversees Medicaid. Medicaid provides funding for a wide range of medical and other services. Coverage is broadest under the Categorically Needy (CN) program and most restricted under the Medically Indigent (MI) program.
In Washington State, Medicaid is referred to as Washington Apple Health
Click http://hrsa.dshs.wa.gov/ If you
do not have access to the internet at home, your local public library will be able to help you find this internet site and get the information.
Medicaid funds many programs of the Developmental Disabilities Administration (DDA). They
include Medicaid Personal Care (MPC), most DDA community services and DD institutions.
STATE SERVICES AND SUPPORTS
The Developmental Disabilities Administration (DDA) is the DSHS (Department of Social and Health Services) entity that provides services only to people eligible for DDA services.
Who does DDA serve?
The Developmental Disabilities Administration (DDA) administers programs and services for people who have the conditions of an intellectual disability, epilepsy, autism, cerebral palsy, or other neurological conditions similar to an intellectual disability.
Contact your local DDA office to apply. The Administration operates local offices throughout the state (see back of this booklet for office numbers).
What are the services?
The Administration offers a broad range of in-home and out-of-home community services as well as institutional services. Services may be provided by state employees and/or contracted providers.
Services are listed as follows.
Is the DDA Home and Community Based Waivers (HCBS) a Medicaid Program?
The HCBS Waivers waive federal rules to allow the use of Medicaid dollars to pay for many DD services. The purpose of the Waivers are to prevent institutionalization by offering a community alternative. The Waivers have a fixed number of people with developmental disabilities who can be served.
NEW HCBS WAIVER: INDIVIDUAL & FAMILY SERVICES WAIVER
The Individual and Family Services (IFS) Waiver was approved by the Centers for Medicare and Medicaid Services (CMS) on June 1, 2015. The IFS Waiver is designed to support participants age 3 and older in their family homes with a range of services and supports and annual benefit packages from $1,200 to $3,600 per year. The IFS Waiver is the fifth DDA waiver and compliments the Basic Plus, (CIIBS) Children’s Intensive In-Home Behavioral Support, Community Protection and Core Waivers.
Click here to go to the WA State DDA website.
What is the Community First Choice (CFC) Medicaid Program?
On July 1, 2015 Washington State implemented a new Medicaid state plan program called Community First Choice (CFC). Community First Choice Services include: Personal Care, Relief Care, Skills Acquisition Training, Personal Emergency Response Systems (PERS), Nurse Delegation, Assistive Technology, CFC, Caregiver Management Training and Community Transition.
If you have questions about these services or about which services you my be eligible to receive, please ask your Case/Resource Manager.
Every DD eligible person who receives a paid services is assigned a case/resource manager (CRM). The case/resource manager is responsible for eligibility intake and determination, assessments, service planning and authorization of services. In addition, the CRM will often be able to inform you about other governmental and community resources.
COMMUNITY FIRST CHOICE (CFC) PERSONAL CARE
The Affordable Care Act established the new Medicaid entitlement state plan option, Community First Choice (CFC), which gives clients more service options and allows the state to get a higher federal Medicaid match rate. Clients on CFC must meet institutional level of care and qualify financially.
CFC offers personal care assistance in the person’s home, an adult family home or adult residential care facility. The in-home provider can be a qualified individual of your choosing, even the parent if their son or daughter is 18 years or older, or a licensed home health agency. Beginning July 1, 2015, personal care services are provided by the CFC program.
For CRM for DDA Clients with NO Paid Services:
Region 1: 1-800-319-7116
Region 2: 1-800-974-4428
Region 3: 1-800-735-6740
NOTE: DDA has limited funding and availability for many services. Contact your local DDA office or case/resource manager to learn what is available.
COMMUNITY RESIDENTIAL SERVICES
Residential services are provided to people who require assistance with daily living. Services are divided into facility and non-facility services.
Facility-based means that the place of residence is owned by the service provider. It is not the person’s own home. Facility-based includes:
- Group Homes
- Intermediate Care Facilities
- Adult Family Homes
- Residential Habilitation Centers (RHCs)
- Adult Residential Care (ARCs)
Non-facility-based means the person owns or rents the apartment or house - it is their own home. Private agencies that contract with DDA provide in-home services that may be called:
- Alternative Living (AL)
- Supportive Living (SL)
- Tenant Support (TS)
NON-DDD RESIDENTIAL SERVICES
Nursing Facility (NF) care: The NF determination and payment is authorized by Home & Community Services (HCS) and Aging & Disability Sservices Administration (ADSA) staff.
Assisted Living: These are boarding homes licensed and contracted with ADSA as “Assisted Living” facilities. This service is funded by ADSA under their COPES Waiver. Eligibility and payment for this service is done by ADSA.
EMPLOYMENT AND DAY PROGRAMS
DDA contracts with the counties to provide employment and community access programs for adults. Your DDA case/resource manager must make the referral.
Individual Supported Employment: Placement and follow-up services necessary to help persons with disabilities obtain and continue integrated employment.
Group Supported Employment: Supervised training and employment of small groups of adults with a disability in regular business and industry.
Pre-vocational/Specialized Industries: Training and short term employment in businesses organized to provide training and employment to persons with disabilities. These settings tend to be more segregated.
Community Access: Services assist individuals to participate in activities that promote individualized skill development, independent living and community integration. Activities must provide individuals with opportunities to develop personal relationships with others in their local communities and to learn, practice and apply life skills that promote greater independence and community inclusion.
Individualized Technical Assistance: Services are a part of an individual’s pathway to individual employment. This service provides assessment and consultation to the employment provider, client and their support system to identify and address existing barriers to employment. This is in addition to supports received through supported employment services or pre-vocational services for individuals who have not yet achieved their employment goal.
Division of Vocational Rehabilitation (DVR) : Provides time limited assistance with employment such as assessments, job placement and short term on-the-job training.
Developmental Disabilities Administration (DDA)
Pierce and Kitsap Counties
West and SW Washington
DDD Central Office
The Arc of Washington State
ADSA - Aging & Disability Services Administration
AL - Alternative Living
ARCs - Adult Residential Care
CFC - Community First Choice
CIIBS - Children’s Intensive In-Home Behavioral Support
CMS - Centers for Medicare & Medicaid Services
CN - Categorically Needy
CNP - Categorically Need Program
COPES - Community Options Program Entry System
CRM - Case/Resource Manager
DAC - Disabled Adult Child Benefit
DCB - Disabled Child Benefit
DDA - Developmental Disabilities Administration
DSHS - Department of Social & Health Services
DVR - Division of Vocational Rehabilitation
HCA - Health Care Authority
HCBS - Home & Community Based Services
HCS - Home & Community Services
IFS - Individual & Family Services
MI - Medically Indigent
NF - Nursing Facility
PERS - Personal Emergency Response Systems
RHCs - Residential Habilitation Centers
SL - Supportive Living
SSA - Social Security Administration
SSDI - Social Security Disability Insurance
SSI - Supplemental Security Income
TS - Tenant Support
This publication is paid through a grant from the DSHS Developmental Disabilities Administration.