RIHHSeligibility

8/6/2019 RIHHSeligibility

http://slidepdf.com/reader/full/rihhseligibility 1/32

SFY 2012

Health and Human ServicesEligibility and Service Fact Book



Table 1: Demographic Comparison of RI, CT and MA

Rh d ode Islan Connecticut Massachusetts

Population 2010 1.05M 3.52M 6.60MMedian Income –

Family of three

2/2010

$73,619 $84,873 $82,883

Percent in Poverty At or below

100%FPL

• Children ≤ 18• Adults 18‐64• Elders 65 and

older

12 s)% (Individual8% (Families

24%16%13%

[19% of these re older than75]

a

9% (Individuals)7% (Fa ilies)m

15%12%9%

[11%of these are older than75]

10 )% (Individuals7% (Fa ilies)m

20%14%11%

[12% of these are olderthan 75]

Percent Change in

SNAP Participation

2007 2010

22% 17% 10%

Percent of Population SSI

Beneficiaries 2009

9% total pop.94% 65

1≥ Age

7.4% total pop94% 65

1 .≥ Age

7% total pop.

89% 651

≥ AgeSSI w/disabilities as

% of total pop 2.7% 1.4% 2.1%Unem e ployment Rat

February 2010• February 2011

• 1 11.2%11.8%

9.2%9.0%

8.7%8.2%

Rate of Uninsurance

2010 12% 16% 5%Budget Shortfall SFY 12

YES YES YES

• In Dollars $331 000,100, $3,70 ,0000,000 $1,80 ,0000,000• % SFY 2011

Budget 10% 28% 5.7%Sources include: cbpp.org/cms/:statehealthfacts.org; census.gov;socialsecurity.gov/policy/docs; ctkidslink.org/pub/

1



Table 2: Medicaid/CHIP: Comparison of RI, CT and MA By

Population

SFY 2009

Rhode slandI 1 Connecticut 2 Massachusetts 3

Per M er

Mont ember P

• h(PMPM)

n•

ChildreParents/Adults

• lities

Adultsw/DisabiElders

• ds

• Childrenw/Special Nee

• Personal Care

$246$369

$1,787

$2,057

$1,4350

$246$309

$2,096

$2,110

$1,6330

$292$345$949

$1,467

$1,038 $84 2

Average PMPM

Mandatory Eligibles $729 $801 $691

Average PMPM

Optional Eligibles $926 $1,112 $1,223

Percent of Enrollees

Mandatory Eligible 59% 51% 54%

Total Average

Enrollment 175,061 4 55,133 1, 2177,92

Enrollment as % of State Population

16.6% 12.9% 17.9%

Total Program

Spending – All Funds $1,70 ,284 2,972 $6,03 ,239 5,281 $12,4 ,429 80,644

Spending as % of

Total State Budget 24.5% 25.2% 26.3%

1 Source: RI Medicaid Annual Expenditure Report.2 Source: State Budget Review and Analysis 200902100 at: ct.gov/opm ctkidslink.org/ub_details_506.html\ 3 Source: MassHealth Summary Report at: mass.gov/eohhs/masshealth/

2



Table 3: RI Medicaid – SFY 2010

Mandatory v. ptional Populations OFederal Mandatory Populations Optional Populations

Enrollees:105,559

Total Expenditures: $960,920,647

Enrollees:77,148

Total Expenditures: $875,184,003

Recipients of Supplemental SecuritytyIncome (SSI) or Supplemental Securi

Disability Insurance (SSDI)Low income Medicare beneficiaries;

CFamilies with income up to 1996 AFDStandard ‐‐ 110%FPL

nt FPL

Children under age six and pregnawomen with family income ≤133 %

edInfants born to Medicaid‐enrollpregnant women;

Children who receive adoptionassistance or who live in foster care,

V‐Eunder a federally‐sponsored Title Iprogram.

Persons meeting the financial andeligibility requirements for aninstitutional level of care: hospital,nursing facilities, or ICF/MR

ilitiesNon‐SSI elders or adults with disabwith income from 74%‐100% FPL

Aged and Persons with Disabilitiesreceiving Home and Community BasedServices with income up to $300% SSIlevel ($2022 per month)

Children up to age 6 with family incomefrom 133‐250% FPL

‐Children age 6‐19 with income from 133

250% FPLParents in families with income ≤ 175%

Individuals determined to be “medicallyrcesneedy” due to low income and resou

or to large medical expenses Children under 18 with a disabling

condition severe enough to requireinstitutional care, but who live at home(the “Katie Beckett” provision) withincome ≤250%FPL

Women eligible for Breast and CervicalCancer program

3



Table 4a: RI Medicaid – SFY 2010

Expenditures for Mandatory v. Optional Populations

Number of Enrollees and Per Member Annually

Population/ Delivery

System

Mandatory Optional Total

Chi IteSha

ldren— RIte Care/R

• reNumber Enrollees

• Annual Cost

≤133% FPL 3 (or $2,054) 4

59,906$3,444

133‐ PL 5 250%F(or $2 860),054‐3,

21,948$2,494

81,854$3,189

Par teSha

ents – RIte Care/RI

• reNumber Enrollees

• Annual Cost

≤110% LFP(or $1,558 )

7,615$7,744

110 PL‐175% F(or $1 702),558‐1,

34,491$4,108

42,106$4,766

Adults w/Disabilities

Primary Care – Rhody Healthor Connect Care Choice

TC – Institutional and HCBerv

Ls

ices

• Number Enrollees• Annual Cost

SSI Recipient Inco PLme ≤ 4% F

(or $671)7

6

30,542$19,615

74‐100% FPL(or $671‐ 907.50)

(o300% SSI HCBSr $2,022 per mo.)

Medically Needy

10,688$29,940

41,233$22,292

Elders Primary Care(Medicare, Non‐duals in

eRhody Health or Connect CarChoice)LTC HCBserv

‐ Institutional and

• icesNumber Enrollees

• Annual Cost

SSI Recipient ≤74% FPL(or $671)

7,396$13,056

74‐100% FPL(or $671‐ 907.50)

(o .)300% SSI HCBSr $2,022 per mosMedically Needy

10,021$35,798

17,417$26,141

Children w/Special Needs –

Rite Care/Rite Share forFoster Kids, SSI & AdoptionSub Fee forServ

sidy; Katie Beckett–

• ice

Number Enrollees• Annual Cost

SSI, Foster Care,Adoption Subsidy,Pediatric Nursing

Facility

10,030$17,040

Kate ildBeckett – ch≤250% FPL(or $2,269)

2,732$15,253

12,403$16,698

Total Number Enrollees 105,459 77,148 182,608

Total Average Annual Cost $9,112 $11,344 $10,055 Total Expenditures $960,920,647 $875,184,003 $1,863,000,000

Federal Funds for Costs Not Other(CNOM

wise Matchable

) Under Medicaid

$17,800,000

Source: Derived from MMIS data prepared for the SFY 2010 RI Medicaid Annual Expenditure Report

4



Table 5: RI Medicaid – SFY 2010

Mandatory v. Optional Services Federal Mandatory Services Optional/Waiver Services

Expenditure: $1,294 M Expenditure: $542 M

Acute Care

Physicians’ services

sLaboratory and x‐ray service

Inpatient hospital servicesOutpatient hospital services

Early & periodic screening, diagnostic) forand treatment services (EPSDT

individuals under age 21Family Planning and supplies nterFederally qualified health ce

(FQHC) servicesRural health clinic services

nt Nurse‐midwife services to the extepermitted by State law

Services of certified pediatric andfamily nurse practitioners to the extent they are authorized to practice underState law

Institutional Services

Nursing facility services for individuals21 and older

Home and Community Based Services

Home health care services for anyindividual entitled to nursing facilitycare

Acute Care

Rehabilitation and other therapiesPrescription drugs

remedial care furnishedners

Medical care or

by other licensed practitio

Clinic services

ME

Dental services, dentures

Prosthetic devices, e

yeglasses, D Primary care case management TB‐related services

Other specialist medical or remedial care

Institutional Services

heIntermediate care facility services for t mentally retarded (ICF/MR)

Inpatient/nursing facility services forindividuals 65 and over in an institutionfor mental diseases

Inpatient psychiatric hospital services forindividuals under 21

Home and Community Based Services

ased WaiverHome and Community B

ServicesOther home health care

Targeted case management es for ventilatorRespiratory care servic

uals

dependent individ

Personal care services

Hospice Services Services furnished under a Pace Program

5



Table 5a: RI Medicaid

Potential Impact of Changes in Optional Populations and Services

Allowed Under Federal Health Care Reform 7

( Pe iance is loss of FMAP) nalty for NoncomplOptional Population/MOE 8 Person/Provider Impact Estimated Fiscal Impact

Parents

• 110 175% FPL

State may request hardshipwaiver and reduce eligibility to133% FPL for 18 months

If waiver is approved:• Eligibility lowered to ≤133% FPL

(or $2,054)• 6,643 p ar ents lose coverage for 18

months 9

SFY 12 –13 (18mos)

$15,100,000 (F)

$14,100,000 (GR)

$29,687,000 (All Funds)

Major Optional & Waiver

Services Expenditures

SFY 2010 10

Behavioral Health 11 Would significantly reduce behavioralhealth services for adults 19‐64 and for

children and elders in certain setting. Mayreduce provider revenues by up to 60% ‐‐CMHC, Inpatient Psych.

$58,786,481(F)

$39,645,232 (GR) $111,325,025(All Funds)

Dental Eliminates all services for all populationsings.in both acute and long‐term care sett

$5,962,804 (F)

$5,294,142(GR)

$11,256,947(All Funds)

Elders & Disabled HCBS12 Services and supports enabling bothpopulations to remain in the community

ewould be eliminated. Nursing home carutilization would increase

$36,242,074(F)

$32,177,926(GR)

$68,420,000(All Funds)

MR/DD includes HCBS (group

homes and shared living) and

Institutional ICF/MR

(Zambarano)

Would eliminate MR/DD services bothinstitutional and in the community basedsetting as well as all long‐term careservices not covered instate plan

$107,405,337 (F)

$95,361,015

(GR)

$202,766,353(All Funds)

Pharmacy All pharmacy is optional service inerMedicaid. Benefit could be limited rath

than eliminated, however.

$42,948,076(F)

$38,131,924 (GR)

$81,080,000(All Funds)

Outpatient Services Reductions in services extend to clinicsbased and community treatment setting

and hospice.

$14,391,245 (F)

$12,777,425 (GR)

$27,168,671(All Funds)

CNOM 13

State is required to extendMedicaid coverage in to many of individuals ≤133% FPL coveredby CNOMs in 2014

Under Global Waiver, any reductions ineligibility for optional populations results in elimination of CNOM . State may not beable to maintain GR programs now fundedby CNOM.

SFY 12

$20,100,000 (F)

$18,700,000 (GR)*

*Only if state programseliminated

Source: MMIS data prepared for the SFY 2010 Medicaid Annual Expenditure Report

6



Table 6: Pub and MA licly Funded Health Coverage: Comparison: of RI, CT 14

Legend: SF= state funded SS= State subsidized; LBP=limited benefit package*FPL=2011 federal poverty level –in dollars, per month (pm) for family of 3

Rho nd de Isla Connecticut Massachusetts

1. Children ≤ age 19 250%FPL(or $3,088)

300% FPL 15 (or $4,633)

300% FPL 16

(or $4,633)2. Parents 175% FPL

(or $2,702)185% FPL(or $2,857)

185‐ P)

300 (LB(or 3)

% FPL (SF) 17

$2,857‐4,63

133% FPL(or $2,054)

13

3‐30 BP)(or 3)

0% FPL (L 18 $2,054‐4,63

3.Pregnant Women 250% FPL 19

(or $3,088)250% FPL(or $3,088)

300 %FPL(or $4,633)

4. Legal Permanen t Resident Children 20

25 L(or $3,088)

0% FP 300%FPL(or $4,633)

300% FPL(or $4,633)

5. Other NonDisabled Adults –

Under age 64

None 58‐68 P)%FPL‐no SSI (LB 21 (or $896‐1,050)

68% P)

& Up ( F)(LB($1,050‐up)

S 22

133‐300% FPL (LBP) 23 (or $2,054‐4,633)

6. Aged, B iisabled :

ligibility

l nd and

DE 24

Resource Limit

100% FPL(or $1,544)

$4 l000‐ Individua$6000‐Couple

58‐68 FPL%(or $896‐1,050)

68% if FPL to 300% SSIHCBS eligible

( 2$or $1,050‐2,02 )1600‐ Individ ua l$2400‐Couple 25

Over A FPLge 65 100%–(or $1,544)

Un

der Age 65 – 133% 26 (or $2,054)

O :$2 l

ver age 65 Only000‐ Individua

$3000‐Couple

7. Medically

eedy 27

onthly IncomeNMLimit 2010

esource Limit R

$903 ‐‐ Individual$1215‐Couple


$4 l76‐576 – Individua$634‐ 734 Couple 28


$ l903 or $1200 29 ‐Individua$12 ple15 or $16 15 30 Cou


7



Table 6: Publicly Funded Health Coverage: Comparison: of RI, CT and MA 14 Legend: SF= state funded SS= State subsidized; LBP=limited benefit package*FPL=2011 federal poverty level –in dollars, per month (pm) for family of 3

Rhode Island Connecticut Massachusetts

8.

TEFRA Katie

eckett (KB) BProvision 31

Age Limit

inancial Eligibility F

linical Eligibility C

Resource Limit

KB State Plan No Limitations

≤ 18

250 % nly)FPL (Child O(or $2,269)

Meet SSI disability criteriaand Institutional level of care

$4000 (child only)

KB Waiver Enrollm apped ent C

None

Up SSIto 300% of (or $2,022)

Meet SSI criteria for asevere disability requiringICF/MR level of care

$1000

Kayleigh Mul igan Waiver l (KB er) Waiv

≤ 18

Child’s income ≤ $60 mos.

Meet SSI disability criteriafor a severe disabilityrequiring hospital or

pediatric nurs ng facilitylevel of car ie

$2000 9. Long term Care

inancial Eligibility F

y Clinical eligibilit Resource Limit

Medically Needy or300% of SSI

(or $2,022 per mos.)

Institutional level of care,based on functional need

000‐ Individua$4000‐Couple

$2 l





$2 l





$2 l

8



Table 6: Publicly Funded Health Coverage: Comparison: of RI, CT and MA 14 Legend: SF= state funded SS= State subsidized; LBP=limited benefit package*FPL=2011 federal poverty level –in dollars, per month (pm) for family of 3

Rhode Island Connecticut Massachusetts

10.

Developmentaisability Waiver

inancial Eligibility

l

DF

linical eligibility C [See also

accompanying

eport by Burns &

ssociates, Inc.]

r A

Resource Limit

Medically Need or300% of SSI

mo.)(or $2,022 per A severe, chronicdisability of a personattributable to a mentaland/or physicalimpairment, manifestedbefore age22 and is: likely

to continue indefinitely;results in substantialfunctional limitations in 3or more areas of majorlife activity; and: reflectsthe need for special,interdisciplinary, orgeneric care, treatment, orother services which arelife‐long or of extendedduration and areindividually planned and

coordinated. 32



(or $2,022 per mo.)

Significantly sub averagegeneral intellectualfunctioning w/deficits inadaptive behaviormanifested duringdevelopment period



(or $2,022 per mo.)

Adults over 18 with mentalretardation or for children,under age 8, must haveautistic disorder, Retts,childhood disintergrativedisorder, PDD, or Aspergers

AND severe behavioral ,communication, or socialdeficits interfering withability to remain in thehome or community were it not for waiver services


9



Table 6: Economic Security Programs: Comparison of RI, CT and MA

SFY 2010 Rhode Island Connecticut Massachu setts

TANF

Cash Assistance

RIWorks 33 Job’s First – TemporaryFamily Assistance 34

TAFDC35

Monthly Income Limit Earned and Unearne d$1,832 (family of 3) 36

Gross: <75% State MedIncome (SMI) ‐‐$4,153(1 parent/ family of 3)

ian Gross: <50% SMI ‐‐$1,724 37 (family of 3)

Net: $1,171 E 38 $1,143 Nonexempt

xempt

Asset Limit $1000 $3000 $2500Periodic Time Limit

24 months in any 60 mos.t od ime peri 21 mos. 39

No more than 24 continuousmonths in a 60 mos. Period

State lifetime limit 48 mos. 40 60 mos. NoneState Program

No

Solely State Funded(2 parent families &

persons exempt from timelimit)

Separ gramate State‐funded Pro(Exempt recipients)

Number

TANF

Participants

18 s,197 Recipient 7,87 ilies5 Fam

33,551 Recipients1 ies7,774 Famil

97,967 Recipients49,86 ilies3 Fam

Monthly Benefit

Family of 3 $554 $42 43‐$67 41 $618

% Change in

Caseload SFY 07 10 ‐37.3% 4.2% 8.3%

Total TANF Block

Grant $95,021,587 $ 266,788,107 $ 459,371,116

State MOE Required $64,391,587 (80% of Total) 42

$183,421,00(75% of Total)

$358,900,00(75% of Total)

Basic Assistance

Expenditures

SFY 2010

Total Basic Assis ta nce

$43,985, 118

From Block Grant

$43,985, 118

General Revenue

0

Total Basic Assistance

$87,563,184

From Block Grant

$12,997,800

General Revenue

$74,565,435

Total Basic Assistance

$308, 078,000

From Block Grant

$48,973,000

General Revenue

$255,104,000

Amount of Block

Grant

Transferred/Spent

Child Care,000$26,0000

dminiA stration

00$9,000,0 Non‐assistance

$5,000,000

Child Care000M$27,000,

dminiA stration

,000$18,000 Non‐assistance

$105,000,000

Child Care000$91,000,

dminiA stration

00$14,000,0 Non‐assistance‐

$150,000,000

10




SFY 2010 Rhode Is and Connecticut Massachusetts l

Child Caressistancligibility

e AE

ork/ActivityW

Co‐pays

I=low‐incomeL

Resource Limit

CCAP TANF recipient OR

EMPLOYED and withincome < 180%

PL($2,206 per month forFfamily of 2):

TANF must be in approvedwork plan activity.

therwise, parent must ork at least half time

Ow

None for TANF

aries from 0‐8% income V

$10,000 liquid assets forlow‐income only

Care 4 Ki

ds

TANF recipient OR

EMPLOYED and < 50%State Median Income (SMI)$2,879 per month for(

family of 2) 43

Work at least half time orattend approved training

rogram. None for teenarent, caretaker relative

pp

None for TANF

Up to 100% of state rate

None

DTA

ildTANF, SSI recipient, foster chOR<50% State Median IncomeSMI) ($2,7 93 per month foramily of 2)

(f 44

Work at least half time, work search, maternity leave,education/training, special

eeds child, homeless, activelder

nmilitary, 65 or o None for TANF

Up to 10% of family income

None

SFY 2010Average

Children Served 6,499 14,000 24,800

SFY 2010

Expenditures

$46,836,783 $101,997,000 $389,704,000

Federal Share

State General

Revenue

$39,689,026

$7,147,757

$91,997,000

$10,000,000

$348,682,120

$41,021,880

11




SFY 2010 Rhode Island Connecticut Massachusetts

Optional State

Supplement to SSI

(I=individual, C=Couple)

SSI Eligible and Livi

ng in:

Own ho usehold$40 (I)$79 (C)

Househ herold of ot $52 (I)$97 (C)

itle XIX facilityT$20

ssisted gA Livin $538

SSI Eligible and Living in:

Independently$168(I)$274(C)

Title XIX facility$39(I)$78 (C)

oom &R BoardBased on cost

SSI Eligible and L

iving in:

Own household‐$114‐128 (I)$180‐636 (C)

Household of other$88‐374 (I)

(C)$194‐215

Title XIX facility$43 (I)$86 (C)

Assisted Living $454 (I)$681(C)

Licensed Rest Home149‐293 (I)

23 (C)$

$636‐9 45

Shared Living$30‐150 (I)

$180‐636 (C)Total Average

Beneficiaries 32,050 10,240 187,359

SFY 2010

Expenditures $22, 249,416 $43,100,001 $222, 311,000

12




SFY 2010 Rhode Island Connecticut Massachusetts

Other Public

Assistance

General Public

Assistance

Hardship – ≥19 unable toork for ≥30 due toisability

wd

ncome Limit: $327(I)449 (couple) per mos.

I$

Asset limit: $400

Bridge – Same as above,but applied for SSI. Re‐paymen fterSSI aw

t required aarded

State Administered

General Assistance

Unemployable due to short‐term condition or in need of transitional assistance

ending disabilitypdetermination

Income Limit:$53 per mos.(homeless); $212

)(family of 2

sset Limit: $250A

Emergency Aid to the Elderly,Disabled & Children

Unable to work due to physicalor mental incapacity lasting at least 60 days; awaiting SSI

etermination; caring ford

ddisabled person; or disable

ncome Limit: TANF levelsI

Asset Limit $250

SFY 2010 Recipients 542

38 Bridge1 Hardship

Total 959

45,000 low‐income adultsicaid intransferred to Med

April 2010.12,000 remained

Not available

SFY 2010 SGR

Expenditures

$1,882,920 SFY 2009 ‐‐$183, 000,000

SFY 2010 ‐ Not Available

$84,658,966

13



14

1 Historical high2 MA does not include the pmpm for personal care assistance in monthly spending by population. The $84pmpm is the average cost pmpm for three populations: adults with disabilities, children with special needs,and elders. The actual amount varies considerably by population from as little as $12 pmpm to as high as

$246 for children with special needs living in the community.3 Poverty Level Children : 0-6 up to 133%; 6-19 100% FPL4 FPL limit per month for family of three, unless otherwise indicated)5 Includes children covered under CHIP and CHIRPRS -- State receives enhanced matching rate6 For SSI recipients and all adults with disabilities and elders, monthly FPL is present for family of one.7 The MOE provisions in the federal Patient Protection and Affordable Care Act generally ensure thatcoverage for adults under state Medicaid program remains in place pending implementation of coveragechanges that become effective in January 2014. The Medicaid MOE provisions relating to adults expirewhen the Secretary determines that an Exchange established by the State under section 1311 of theAffordable Care Act is fully operational. The MOE provisions for children under age 19, in both Medicaidand CHIP are effective through September 30, 2019.8 The MOE provisions in the federal Patient Protection and Affordable Care Act prohibit the states fromreducing eligibility for mandatory populations. States may reduce or eliminate optional services for both

mandatory and optional populations and limit mandatory services for optional populations, but only in anarrow range of circumstances.9 If the hardship waiver is approved, the state may be required to restore eligibility to FFY 2010 levelswhen the exchange is implemented in FFY 2014. Medicaid officials indicated that actual implementation of the roll back can not take effect until the second half of SFY 2012 due to systems challenges. For thesereasons, only 18 months of savings is assumed. Note: When eligibility is restored in 2014, parents will becovered at the current, lower, FMAP rate.10 Waiver includes all optional, non-state plan Home & Community Based Services (HCBS) 11 Includes specialty and rehabilitation services provided through the Community Mental HealthCenters (CMHC) and health plans as well as certain in-patient psychiatric services, substanceabuse and other community based services 12 Covers personal care, case management, assisted living and an array of other non-state planservices provided to elders and persons with disabilities in non-institutional settings 13 Under the terms and conditions of the Global Consumer Choice Waiver, any reductions in eligibility willresult in the loss of federal CNOM dollars14Medicaid/CHIP unless designated as state-funded (SF) or as state subsidized (SS) with the beneficiarypaying the remaining costs. Limited benefit package (LBP) means less comprehensive coverage than underfull Medicaid.15 HUSKY B is CHIP funded from 185-300% FPL w/sliding scale premiums. There is a buy-in for kidsw/income above 300 FPL16 State-Subsidized – 300% FPL Up (LBP)17 State-subsidized Buy-in – 300-400% FPL (LBP)18 State-Subsidized – 300% FPL Up (LBP)19 State subsidized Buy-in – 250-350% FPL (LBP)20 CT and RI funded through CHIRPA Special Enhanced Match21 Only for adults age 19-64 who do not qualify for Supplemental Security Income (SSI)22 Charter Oak Health Plan available to any uninsured adults for $307 per month regardless of income(LBP)23 State-Subsidized – 300% FPL Up (LBP)24 FPL adjusted for family size of one.25 State-Subsidized Buy-in – 300-400% FPL; Resource Limit: Same26 State-Subsidized – 133% FPL Up Resource Limit :$2000- Individual $3000-Couple27 Beneficiary’s income exceeds eligibility limits, but has high medical expenses. Once beneficiary spendsdown to monthly limit, receives Medicaid coverage for all State Plan Services.28 Amt varies by region



15

29 Higher amount if beneficiary qualifies for personal care assistance30 Higher amount if beneficiary qualifies for personal care assistance31 Tax Equity and Financial Responsibility Act of 1982 ( TEFRA) gave the states the option of adopting aKatie Beckett waiver or state plan amendment (SPA). The waiver option gives the states the flexibility toimplement higher/lower age and income limits, cost-sharing, and waiting lists and to provide a more

limited benefit package. The SPA option provides full comprehensive benefits and requires states to coverall state plan services as well as any determined to be medically necessary. The SPA option does not permitenrollment caps or waiting lists.32 Based on the federal Developmental Disabilities Act of 2002, as amended.33 Must be engaged in work or job-readiness program34 Must be engaged in work or job-readiness program35 Cash assistance while engaged in employment, education, or training related to job permanency . 36 Maximum earned and unearned monthly income limit37 State Median Income for SFY 2010 $41,396 for family of three. Changed from 85% SMI January 2010families exempt from the work requirement, gross income for a family of three =$1,171.38 Exempt recipients not subject to time limits and hardship families. Benefits provided through separatestate program funded through Maintenance of Effort (MOE) funds.39 Six month extensions granted in increments up to lifetime limit if working & income remains <75%

SMI; two additional 21 month extensions granted if hardship requirements are met40 Initial hardship extension of 6 months; with eligibility for additional 6 months41 Varies by region42 States are assigned a 70% or 80% Maintenance of Effort (MOE) requirement based on a variety of factors related to historic expenditures, worker participation rates and various credits.43 Prior to 11/06/10, income limit for employed was 75% of SMI $4,319 per mos for family of two.44 Families remain eligible until reach $100 of SMI45 Amt. above varies by aged, blind, disabled eligibility category)



MEMORANDUM

March 29, 2011

To: Craig StenningFrom: Peter Burns and Mark Podrazik RE: Comparing State Definitions of ID/DD

You recently posed the question as to whether or not the Rhode Island definition of developmental disabilities is more liberal than surrounding States and/or the States in general.This memo has been prepared to explore that question.

The background research that was conducted for this memo included a review of federal statutes,regulations and 1915(c) Waiver instructions; the selection of 10 northeastern States 1 for closerexamination of statutes, regulations and waivers; and a review of selected publications of theAmerican Association for Intellectual and Developmental Disabilities (AAIDD) and the NationalAssociation of Directors of Developmental Disabilities Services (NADDDS).

Our research – particularly on the 10 northeastern States – was primarily focused on thedefinition of developmental disabilities as it is applied to adults, in as much as the mission of theDivision of Behavioral Health, Developmental Disabilities and Hospitals is to provide services toadults in Rhode Island meeting the statutory and regulatory definition of developmentaldisability.

In summary, and as a general conclusion, we believe that Rhode Island’s definition of developmental disabilities is in concert with 39 other States; is approximately equivalent to thedefinition of Maine, New Hampshire, New Jersey, and New York; and broader than thedefinition used in Connecticut, Delaware, Massachusetts, Pennsylvania and Vermont.

The balance of this memo and the Appendices contains the result of our research and isorganized into the following sections: federal definitions, a review of the States in general, adiscussion of the definition used in the 10 northeastern States, and concludes with a brief discussion of options available to control waiver costs for persons with developmentaldisabilities in lieu of a change in definition.

1 The States examined included Connecticut, Delaware, Massachusetts, Maine, New Hampshire, New Jersey, NewYork, Pennsylvania and Vermont (in addition to Rhode Island)



Federal Definitions

The Federal government through the Medicaid program has greatly influenced the definitionsadopted by the States relating to mental retardation (and the more current term of intellectualdisabilities) and developmental disabilities. There are three particular Federal uses of these

terms that have influenced the States: eligibility for services in Intermediate Care Facilities forPeople with Mental Retardation (ICF/MR), eligibility for Section 1915(c) Waivers, and theDevelopmental Disabilities Assistance and Bill of Rights Act of 2000. Appendix A contains thedefinitions used in each of these three instances.

The ICF/MR program was added to Medicaid as an optional service in 1971 to provide Stateswith federal funds for institutional programs serving only individuals with mental retardation.The federal definition provided that matching monies would be available for services provided topersons with mental retardation and related constitutions.

In 1981 the Medicaid waiver program under Section 1915(c) was authorized to provide matching

funds to States for programs that delivered home and community based services (HCBS) as analternative to ICF/MRs. The eligibility definition for the HCBS waivers was directly tied to thedefinition used for ICF/MR – mental retardation and related conditions – and required that theprogram participants need the level of care provided by ICF/MRs.

While federal Medicaid statutes do not define mental retardation 2, the “related conditions”criteria are defined through both examples of medical conditions (cerebral palsy or epilepsy) andthrough functional criteria. The functional criteria in the regulations are:

Persons with related conditions means individuals who have a severe, chronic disability thatmeets all of the following conditions:

(a) It is attributable to—

(1) Cerebral palsy or epilepsy; or(2) Any other condition, other than mental illness, found to be closely related tomental retardation because this condition results in impairment of generalintellectual functioning or adaptive behavior similar to that of mentally retardedpersons, and requires treatment or services similar to those required for thesepersons.

(b) It is manifested before the person reaches age 22.(c) It is likely to continue indefinitely.(d) It results in substantial functional limitations in three or more of the following areasof major life activity:

(1) Self-care.(2) Understanding and use of language.(3) Learning.

(4) Mobility.(5) Self-direction.(6) Capacity for independent living.

2 Though there is broad consensus of the definition of intellectual disability (mental retardation) largely based on thework of AAIDD: Intellectual disability is a disability characterized by significant limitations both in intellectualfunctioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everydaysocial and practical skills. This disability originates before the age of 18.

Burns & Associates, Inc. 2 March 29, 2011



As Zaharia and Moseley (2008) 3 point out, these federal definitions based on the original criteriafor ICF/MRs have led States to adopt eligibility criteria that are differentiated by at least twofactors – a categorical factor that references specific related conditions by medical diagnosissuch as mental retardation, spina bifida, autism, etc., or functional criteria such as contained the“related conditions” definition, or more recently, in the Developmental Disabilities Assistance

and Bill of Rights Act of 2000 (2000 Act).The 2000 Act does not contain any specific medical diagnosis as criteria for “developmentaldisabilities”; it instead is based on a person’s adaptive abilities or capacity to perform tasks at aspecific level:

…a severe, chronic disability of an individual that-(i) is attributable to a mental or physical impairment or combination of mental andphysical impairments;(ii) is manifested before the individual attains age 22;(iii) is likely to continue indefinitely;(iv) results in substantial functional limitations in 3 or more of the following areas of major life activity:

(I) Self-care.(II) Receptive and expressive language.(III) Learning.(IV) Mobility.(V) Self-direction.(VI) Capacity for independent living.(VII) Economic self-sufficiency; and

(v) reflects the individual's need for a combination and sequence of special,interdisciplinary, or generic services, individualized supports, or other forms of assistancethat are of lifelong or extended duration and are individually planned and coordinated.

Adding further complexity to the comparativeness of State definitions is the flexibility afforded

States under the Section 1915(c) waivers to target specific subgroups of individuals that may beincluded in the larger population that require the ICF/MR level of care because of their “mentalretardation or related conditions”. This targeting may be based on such things as:

• Nature or type of disability;• Specific diseases or conditions;• Functional limitations (e.g., extent of assistance required in activities of daily (ADLs) and/or

instrumental activities of daily living (IADLs); and,• Living arrangement (e.g., persons with developmental disabilities who live with their families

or in living arrangements where fewer than four persons unrelated to the proprietor reside).

Examples of this targeting include Connecticut’s targeting of developmental disability to those

individuals who currently reside in general Nursing Facilities.A National View

In their 2008 paper Zaharia and Mosely surveyed the States to determine the definitions used forboth the ICF/MR and Waiver programs. In all, 47 States participated in the survey

3 State Strategies for Determining Eligibility and Level of Care for ICF/MR and Waiver Program Participants




(unfortunately Rhode Island was not one of them) which allowed the authors to classify andcompare the definitions used. Their paper drew the distinction between the categorical (i.e.diagnosis), functional (i.e. the 2000 Act) and the combination approach to definitions.

The authors concluded that most States – 39 – used a combination approach to the definition.

Further, the authors found that 16 States used the “mental retardation and related conditions”definition and 31 States used the 2000 Act definition, although most of these States added acategorical component. Only eight States used the 2000 Act definition (i.e. “mental or physicalimpairment or combination of mental and physical impairments”) exclusively.

Based on our review of the Rhode Island definition, we suspect that the authors would haveincluded Rhode Island into the group of States that uses the 2000 Act with a categoricalcomponent.

Table 1 that follows is from the Zaharia and Mosely paper. The States are first classified as towhether they use the “mental retardation and related conditions” definition that originated with

the ICF/MR program or use the “Developmental Disability” definition from the 2000 Act (alsoincluded in this latter category are States that use their own definition that is broader than the“mental retardation and related conditions” definition but is not the definition from the 2000Act).

All the responding States appear on the first row of the Table “Mental Retardation, Cognitive orIntellectual Disability” as that is the minimum definition a State may use. The subsequent rowslist the States from the first row that include the specific Diagnostic Criteria indicated (e.g.cerebral palsy, epilepsy, Prader-Willi Syndrome, etc.).

Table 1:Diagnoses Reported by the States for Admission into State and Waiver Programs

Diagnostic Criteria

Mental Retardation andRelated Conditions

Developmental Disability

Mental Retardation, Cognitiveor Intellectual Disability

AL, CT , IA, MA, ME, MN, NE,NV, OK, PA , TN, TX, UT, VA,VT , WY

AK, AR, AZ, CA, CO, DC, DE , FL,GA, HI, ID, IL, IN, KS, KY, LA, MI,MO, MS, MT, NC, ND, NH, NJ , NM,

NY , OH, OR, SD, WA, WVCerebral Palsy NV, PA, TX, UT, WY AK, AR, AZ, CA, CO, DC. FL, GA, ID,

IL, IN, KS, LA, MI, MO, MT, ND, NM, NH , NJ, NY , OH, OR, SD, WA

Epilepsy PA , TX, UT, WY AK, AR, AZ, CA, CO, DC, FL, GA, ID,IL, IN, KS, LA, MI, MO, MT, ND, NH,

NJ , NM, NY , OH, SD, WAPrader-Willi Syndrome CT , NV, TX, UT WY AK, DC, DE , FL, GA, IN, KS, LA, MO,MI, MS, ND, NJ, NY , OH, OR,

Autism MA, ME, PA , TX, UT, WY AK, AR, AZ, CA, CO, DC, DE , FL,GA, ID, IN, KS, MI, MO, MS, MT, ND,

NH, NJ, NM, NY , OH, OR, SD, WA,WV

Autism Spectrum MA , NV, TX, UT, WY CO, GA, IN, KS, LA, MI, MO, ND, NJ ,OH, OR, SD,




Diagnostic Criteria

Mental Retardation and Developmental Disability Related Conditions

Asperger’s Syndrome MA , NV, TX, WY DE , GA, IN, LA, MI, MO, ND, NJ ,NM, OH, OR, SD

Pervasive DevelopmentalDisability

MA , NV, TX, VT, UT, WY AK, GA, IN, KS, LA, MI, MO, MS,ND, OH, OR,

Spina Bifida UT, WY DC, FL, GA, IN, KS, LA, MI, MO, MS,ND, NJ, NM, NY , OH, OR, WV

Fetal Alcohol Syndrome NV, TX, UT, WY AK, GA, IN, KS, LA, ND, NY, OH, OR,SD

TBI before18 CT , WY DE, IN, MO, MS, ND, NY , OR,TBI before 22 NV, TX, UT AK, GA, KS, LA, MO, ND, NJ , NY ,

OH, OR, SD, WVAt Risk before 6 NV, TN, VA AZ, LA, ND, OH, OROther MA, PA , VA AR, CA, CO, DC, DE, ID, IN, LA, MI,

MO, MT, NC, NH, NJ , NM, NY , WA

Twenty-one (21) states reported using “other” diagnostic categories to determine eligibility. Additional conditions

covered by states include: dyslexia (AR), autistic disorder (ME), Retts (MA), specific learning disability (NH),familial dysautonomia (NY), deaf-blind with multiple disabilities (TX), and tuberous sclerosis (WV). The majorityof states do have a catch all eligibility criterion that establishes that persons are eligible who have closely relatedconditions with impairments in major life activities without specifying the condition.

The 10 northeastern States that we examined more closely are in bold italics . Additionalexamination of these States is presented in the following section.

The Definitions of Ten Northeastern States

For this memo we examined (in various levels of detail) the statutory, regulatory and waiverdefinitions, as well as the summaries contained in the Zaharia and Mosely paper of the followingStates: Connecticut, Delaware, Massachusetts, Maine, New Hampshire, New Jersey, New York,Pennsylvania, Rhode Island and Vermont.

The following five States are classified as using the Mental Retardation/Related Conditionscriteria and generally include only a limited number of diagnoses (if any) in addition to mentalretardation:

• Connecticut• Maine• Massachusetts• Pennsylvania• Vermont

Maine is unusual in this group in that Zaharia and Mosely classify the State as MentalRetardation/Related Conditions, but an examination of the Maine statute reveals that it containsthe 2000 Act definition (see 5 M.R.S.A. 19503.3).




Only New Jersey among the group of 10 States is reported to use the 2000 Act definitionexclusively, and is included by the authors as one of the eight States that does so across thecountry.

The remaining four of the ten northeastern States (including our designation of Rhode Island) use

what is labeled as “State DD Definition”:• Delaware• New Hampshire• New York • Rhode Island

Including New Jersey but excluding Rhode Island, the authors note in Table 1 that for theremaining four States: all of them include autism, traumatic brain injury and “other” conditionswhile three of the four include (in various combinations) cerebral palsy, epilepsy and Prader-Willi. In examining New Hampshire’s statute we found that it includes both “a specific learning

disability” and “any other condition… closely related to an intellectual disability” in that State’sdefinition.

Included as Appendix B is the “State Eligibility Criteria” reported by the authors in their paperfor the nine northeastern States.

Based on this review and our examination of various statutes – most particularly of the six NewEngland States – we conclude that the Rhode Island definition used for developmentaldisabilities is perhaps more “liberal” than the definition used by the New England States –definitely so compared to Connecticut and Massachusetts, but is generally in line with the rest of the States in the nation.

However, if the concern over the definition of developmental disabilities in Rhode Island isrooted in the funding commitment of the program, there may be more surgical and equitablepublic policy options to consider before considering a change to the current definition. Theseoptions will be briefly summarized in the final discussion of this memo.

Options to Constrain Funding for Developmental Disability Services

The evidence suggests that compared to most States, Rhode Island:• Commits a greater fiscal effort to developmental disability services, and• Has, in the last few years, reduced that commitment more significantly than all the other

States

Braddock in 2009 reported that Rhode Island ranked 9 th among the States in fiscal effort 4 at$6.35, compared to the national average of $4.35 and the lowest State (Nevada) at $1.55.However, the $6.35 is, also according to Braddock, down from the 2006 level of $7.18 andrepresents a reduction of approximately 12%, which is the largest percentage reduction in the

4 Defined as spending for developmental disability services per $1,000 of aggregate statewide personal income




nation. But continuing stress in the State’s fiscal situation is undoubtedly prompting policymakers to a relentless search for avenues to constrain or reduce funding requirements.

We suggest there may be better alternatives to constrain or reduce funding levels than modifyingRhode Island’s definition of developmental disability. We frankly believe that the current

Project Sustainability is the most thoughtful and appropriate alternative.Project Sustainability is an ambitious effort to measure and track the services purchased withpublic dollars, establish fair and equitable rates to compensate providers for the services the Statewishes to purchase (as opposed to the services the providers wish to deliver), implement a validand reliable assessment tool to measure participant’s support needs, put in place new automatedmanagement tools, and have a program that provides appropriate, quality services to participantsbased on their need for public supports.

Separate and apart from Project Sustainability – and without completely understanding thefreedom (or lack thereof) that the Global Waiver affords Rhode Island – the Medicaid Waiver

program has at least five available options to constrain or reduce funding. These five optionshave some serious implications – particularly given the State’s current situation – but may bemore desirable than changing the definition of developmental disability. These options include:

• Capping the number of individuals that can participate in the HCBS program• Only permit future entrants into the HCBS program that are members of targeted

subgroups of the population with developmental disabilities• Establish annual cost limits on the amount of resources that are devoted to support any

single individual• Limit the amount, duration or scope of the HCBS services offered• Limit or reduce the rates paid to providers of services

A full vetting of these options is beyond the scope of this memo and are only offered as acontrast to changing the State’s long held commitment to providing needed services toindividuals that are afflicted with serious mental or physical impairments, regardless of thecause.

If this memo leaves you with any questions or you would like to discuss the material containedherein, please contact us.




Appendix AFederal Definitions Relating to Mental Retardation and Developmental Disabilities

§ 42 CFR 435.1010 Definitions relating to institutional status.

Institution for the mentally retarded or persons with related conditions means an institution (ordistinct part of an institution) that—

(a) Is primarily for the diagnosis, treatment, or rehabilitation of the mentally retarded orpersons with related conditions; and(b) Provides, in a protected residential setting, ongoing evaluation, planning, 24-hoursupervision, coordination, and integration of health or rehabilitative services to help eachindividual function at his greatest ability.

Persons with related conditions means individuals who have a severe, chronic disability thatmeets all of the following conditions:

(a) It is attributable to—(1) Cerebral palsy or epilepsy; or(2) Any other condition, other than mental illness, found to be closely related tomental retardation because this condition results in impairment of generalintellectual functioning or adaptive behavior similar to that of mentally retardedpersons, and requires treatment or services similar to those required for thesepersons.

(b) It is manifested before the person reaches age 22.(c) It is likely to continue indefinitely.(d) It results in substantial functional limitations in three or more of the following areasof major life activity:

(1) Self-care.(2) Understanding and use of language.(3) Learning.(4) Mobility.(5) Self-direction.(6) Capacity for independent living.

§ 42 CFR 441.301 Contents of request for a waiver.

(b) If the agency furnishes home and community-based services, as defined in § 440.180 of thissubchapter, under a waiver granted under this subpart, the waiver request must—

(1) Provide that the services are furnished—(iii) Only to recipients who the agency determines would, in the absence of theseservices, require the Medicaid covered level of care provided in—

(C) An ICF/MR (as defined in § 440.150 of this chapter);




Application for a §1915(c) Home and Community-Based Waiver [Version 3.5],Instructions, Technical Guide and Review Criteria; January 2008

Participants in a waiver linked to the ICF/MR level of care must meet the “related condition”

definition when they are not diagnosed as having an intellectual disability (e.g., persons withautism).

Mental Retardation: A condition/disability that is manifested by (1) significant sub-averageintellectual functioning as measured on a standardized intelligence test; (2) significant deficits inadaptive behavior/functioning (e.g., daily living, communication and social skills); and, (3) on-set during the developmental period of life (prior to age 18).

While “Developmental Disability” and “Related Conditions” overlap, they are not equivalent.The definition of related conditions is at 42 CFR 435.1009, and is functional, rather than tied to afixed list of conditions.

More discrete targeting criteria may be specified over and above the target group/subgroup andage-ranges selected in the [waiver application’s] previous item. When additional criteria are notspecified, it is presumed that the waiver is available to all persons who need the level(s) of carespecified in the Application (Module 1) and are in the groups/subgroups selected in Item B-1-a.

The additional criteria may be specified in terms of nature or degree or type of disability, or otherreasonable and definable characteristics that distinguish the target group from other persons whomay need the level(s) of care specified for the waiver. Such additional targeting criteria mayinclude but are not limited to:

• Nature or type of disability;• Specific diseases or conditions;• Functional limitations (e.g., extent of assistance required in activities of daily (ADLs)

and/or instrumental activities of daily living (IADLs); and,• Living arrangement (e.g., persons with developmental disabilities who live with their

families or in living arrangements where fewer than four persons unrelated to the proprietorreside).

Additional criteria also may be specified in order to align the waiver to service populationeligibility criteria that are specified in state law (for example, when a state’s definition of developmental disability specifies that the disability must have been experienced before age 18rather than age 22). In specifying additional targeting criteria, clearly define the terms that areused to specify membership in the target groups.

When the waiver limits the age range of the target population (e.g., to adults with physicaldisabilities through age 64), a state may provide that persons who enter the waiver may continueto participate in the waiver after they reach the maximum age that applies to entrance to thewaiver. If the state provides for continuing individuals on a waiver past the specified maximumage, specify the continuation policies that apply.




A waiver may target exclusively individuals who want to direct at least some or all of theirwaiver services by employing the participant direction opportunities that are specified inAppendix E. This targeting criterion should be reflected here.

The Developmental Disabilities Assistance and Bill of Rights Act of 2000 (P.L. 106-402 – 42USC §15002(8)(A)&(B))

As provided in The Developmental Disabilities Assistance and Bill of Rights Act of 2000, the“term ‘developmental disability’ means a severe, chronic disability of an individual that-

(i) is attributable to a mental or physical impairment or combination of mental andphysical impairments;(ii) is manifested before the individual attains age 22;(iii) is likely to continue indefinitely;(iv) results in substantial functional limitations in 3 or more of the following areas of

major life activity:(I) Self-care.(II) Receptive and expressive language.(III) Learning.(IV) Mobility.(V) Self-direction.(VI) Capacity for independent living.(VII) Economic self-sufficiency; and

(v) reflects the individual's need for a combination and sequence of special,interdisciplinary, or generic services, individualized supports, or other forms of assistancethat are of lifelong or extended duration and are individually planned and coordinated.

“An individual from birth to age 9, inclusive, who has a substantial developmental delay orspecific congenital or acquired condition, may be considered to have a developmental disabilitywithout meeting 3 or more of the criteria … if the individual, without services and supports, hasa high probability of meeting those criteria later in life.”

[N.B., The foregoing definition is not the same as the Medicaid specification of individuals whomay receive ICF/MR services. ICF/MR services are furnished to persons with mental retardationand other related conditions. When a waiver targets individuals with developmental disabilities, astate should define its use of the term “developmental disability.”]




Appendix BSelected State Eligibility Criteria From:

“State Strategies for Determining Eligibility and Level of Care for ICF/MRand Waiver Program Participants” (2008)

Connecticut

Mental Retardation/Related Conditions Definition :Must have significantly sub average general intellectual functioning existing concurrentlywith deficits in adaptive behavior and manifested during the developmental period or amedical diagnosis of Prader-Willi.Citation:Conn. General Statute Sec. 17a-210

DelawareState DD Definition:Must have mental retardation, autism, Aspergers, Prader-Willi, or Brain Injury during thedevelopmental period with concurrent adaptive limitations.Citation :Delaware Register of Regulations (3-1-08),

Maine

Mental Retardation/Related Conditions :Must have diagnosis of mental retardation or autism/autistic disorder; must showimpairments in one domain of Activities of Daily Living; must meet criterion on BMS-99Citation:http://www.maine.gov/sos/cec/rules/10/144/ch101/c2s021.doc

Massachusetts

Mental Retardation/Related Conditions:Adults over age 18 must have mental retardation or, for children, 8 or under, must haveautistic disorder, Retts, childhood disintegrative disorder, PDD, or Aspergers, with severebehavioral, communicative, or social deficits that interfere with the ability to remain inthe home or the community; must meet criterion on the MASSCAP.Citation :http://www.mass.gov/dmr Regulations, Ch.6

New Hampshire

State DD Definition :


http://www.maine.gov/sos/cec/rules/10/144/ch101/c2s021.doc

http://www.maine.gov/sos/cec/rules/10/144/ch101/c2s021.doc



A disability which is attributable to mental retardation, cerebral palsy, epilepsy, autism, aspecific learning disability or any other condition closely related to mental retardation,resulting in impairment in general intellectual functioning or adaptive behavior, whichoriginated before age 22 and constitutes a severe disability to function normally insociety;

Citation:NH He-M 524

New Jersey

Federal DD Definition:A severe, chronic disability attributable to mental or physical impairments, manifestingbefore age 22 and resulting in substantial functional limitations in 3 or more areas of major life activity; for those over age 12, must meet criterion on the Self CareAssessment Tool.

New York State DD Definition :A disability that is attributable to mental retardation, cerebral palsy, epilepsy, autism,neurological impairment or any other condition closely related to mental retardation,resulting in impairment of general intellectual functioning or adaptive behavior andmanifesting before age 22, and constitutes a substantial handicap to the person’s ability tofunction normally in society; dyslexia may be included if resultant of one of the otherrelated conditions.Citation :MHL 1.03 (22); OMRDD Eligibility Determination Policy Advisory

Pennsylvania

Mental Retardation/Related Conditions :Mental retardationCitation :55Pa.Code Chapter 6210: Bulletin 00-08-04

Vermont

Mental Retardation/Related Conditions :Mental retardation or related conditions; must meet criterion on NeedsAssessment/Periodic ReviewCitation:AHS DAIL, Regs. implementing DD Act of 1996




Appendix CNew England States - Comparison of Developmental Disability Eligibility Criterion

State Statute/Administrative Rule

Connecticut

“Mental

retardation”

means

significantly

sub

average

general

intellectual

functioning existing concurrently with deficits in adaptive behavior and

manifested during the developmental period.

(b) As used in subsection (a) of this section, “general intellectual functioning”

means the results obtained by assessment with one or more of the individually

administered general intelligence tests developed for that purpose and

standardized on a significantly adequate population and administered by a

person or persons formally trained in test administration; “significantly sub

average” means an intelligence quotient more than two standard deviations

below the mean for the test; “adaptive behavior” means the effectiveness or

degree with which an individual meets the standards of personal

independence and social responsibility expected for the individual's age and

cultural group; and “developmental” period” means the period of time

between birth and the eighteenth birthday.

C.G.S.A. § 1 ‐ 1g.a

Massachusetts "Person with an intellectual disability'', a person who, as a result of inadequately developed or impaired intelligence, as determined by clinical

authorities as described in the regulations of the department, is substantially

limited in the person's ability to learn or adapt, as judged by established

standards available for the evaluation of a person's ability to function in the

community; provided, however, that a person with an intellectual disability

may be considered mentally ill; provided further, that no person with an

intellectual disability shall be considered mentally ill solely by virtue of the

person's intellectual disability.

M.G.L. 123B.1

Rules: 115 CMR 6 6.04: General Eligibility

(1) Persons who are 18 years of age or older are eligible for supports provided,

purchased, or arranged by the Department if the person:

(a) is domiciled in the Commonwealth; and

(b) is a person with intellectual disability as defined in 115 CMR 2.01.

115 CMR 2.0: Definitions:

“Intellectual Disability” is the preferred term to describe the condition of mental retardation, and, for purposes of 115 CMR 2.00, is synonymous with

the term mental retardation.

“Mental Retardation” means significantly sub ‐ average intellectual functioning

existing concurrently and related to significant limitations in adaptive

functioning. Mental retardation manifests before age 18. A person with mental

retardation may be considered to be mentally ill as defined in 104 CMR





Rhode Island “Developmentally Disabled Adult” means a person, eighteen years old or older

and not under the jurisdiction of the Department for Children, Youth and

Families who is either an MR developmentally disabled adult or is a person

with a severe chronic disability which:

• is

attributable

to

a

mental

or

physical

impairment

or

combination

of

mental and physical impairments;

• is manifested before the person attains age 22;

• is likely to continue indefinitely;

• results in substantial functional limitations in three or more of the

following areas of major life activity:

o self care,

o receptive and expressive language,

o learning

o mobility,

o self direction,

o capacity

for

independent

living,

o economic self sufficiency

• reflects the person’s need for a combination and sequence of special,

interdisciplinary or generic care, treatment, or other services, which

are individually planned and coordinated. (RI Gen. Laws 40.1 ‐ 21 ‐ 4.3

(5))

“MR developmentally disabled adult” means a person 18 years or older and

not under the jurisdiction of the Department of Children, Youth and Families,

with significant sub average, general intellectual functioning two standard

deviations below the norm, existing concurrently with deficits in adaptive

behavior and manifested during the developmental period. (RI Gen. Laws 40.

1 ‐ 21 ‐ 4.3 (8) )

Vermont “Developmental disability” means a severe, chronic disability of a person that

is manifested before the person reaches the age of 18 and results in: (A)

mental retardation, autism or pervasive developmental disorder; and (B)

deficits in adaptive behavior at least two standard deviations below the mean

for a normative comparison group.

18 V.S.A. § 8722

Rules (Division of Aging and Disability Services) – March 2011 Code of Vermont

Rules 13 110 011

1.13 “Developmental Disability” means an intellectual disability or a Pervasive

Developmental Disorder which occurred before age 18 and which has

significant deficits in adaptive behavior that were manifest before age 18.

Temporary deficits in cognitive functioning or adaptive behavior as the result

of severe emotional disturbance before age 18 are not a developmental

disability. The onset after age 18 of impaired intellectual or adaptive

functioning due to drugs, accident, disease, emotional disturbance, or other

causes is not a developmental disability.





1.18 “Intellectual disability” means significantly sub ‐ average cognitive

functioning that is at least two standard deviations below the mean for a

similar age normative comparison group. This is documented by a full scale

score

of

70

or

below

on

an

appropriate

norm‐

referenced

standardized

test

of

intelligence and resulting in significant deficits in adaptive behavior that were

manifest before age 18. “Intellectual disability” was previously known as

“mental retardation” as the term is defined and referred to in the

Developmental Disabilities Act.

1.20 “Pervasive Developmental Disorder” (PDD) means the same as the term

as it is defined in the current Diagnostic and Statistical Manual of Mental

Disorders (DSM). The diagnostic category of pervasive developmental

disorders includes the five diagnoses currently listed in DSM: Autistic Disorder

(Autism), Asperger's Disorder, Pervasive Developmental Disorder, Not

Otherwise Specified, Rett's Disorder and Childhood Disintegrative Disorder.

1.38 “Was manifest before age 18" or “were manifest before age 18” means

that the impairment and resulting significant deficits in adaptive behavior were

observed before age eighteen. Evidence that the impairment and resulting

significant deficits in adaptive behavior occurred before the age 18 may be

based upon records, information provided by the individual, and/or

information provided by people who knew the individual in the past.

RIHHSeligibility

Documents

Transcript of RIHHSeligibility