How to Complete an Application
Those seeking services for persons with intellectual disabilities through ADMH should:
- Contact the Division of Developmental Disabilities Call Center at 1-800-361-4491.
- Within the next business day, an initial contact form will be faxed to the local designated 310 agency (case management agency) or other designated point of entry.
- Once contacted by the 310 agency, you will need to do the following:
- Describe the needs and preferences of the applicant (the person for whom services are being requested).
- Provide information on the applicant’s current situation, personal and family history, and Medicaid eligibility status.
- Additional information to be completed by the designated 310 agency:
- Criticality summary completed within 90 days of application;
- A psychological evaluation with the IQ range of the applicant (IQ score below 70 documented by a standardized intelligence test) including a review of all past intellectual assessments and IQ scores;
- Documentation that the applicant has challenges with adaptive functioning (significant limitations in the applicant’s effectiveness in meeting the standards of maturation, learning, personal independence, and/or social responsibility that are expected for his/her age level and cultural group, as determined by clinical assessment, and usually, standardized scales) such as the ICAP (Inventory for Client and Agency Planning); When there is cause to question the ICAP score, an additional clinical adaptive functioning assessment and other documentation may be requested;
- Documentation that the applicant’s level of adaptive and intellectual functioning occurred prior to the age of 18 (developmental history).
- The 310 agency will submit the completed informational packet for review to the regional community services office that serves the applicant’s county and, if approved, the applicant’s name will be placed on the waiting list. ADMH will make a determination of eligibility within 30 days of the receipt of the completed application. Note: the date of application, is the day a completed packet is received at the regional community services office.
Administrative Review Options
Once the 310 agency has provided a complete application to the regional community services office, the division will make a determination of eligibility no later than 30 business days after receipt. Note: if the application has to be sent back to the 310 agency for more information, it is not considered complete.
If the applicant is determined eligible, his/her name will be added to the waiting list. The applicant will receive a memorandum (an Initial Notification of Preliminary Determination of Eligibility) from the division stating they have been added to the waiting list indicating the service groups for which the applicant is shown to be waiting. This notification will also explain how the waiting list works.
A second page describes how to request a review if the applicant disagrees with being entered on the waiting list or with the specified service groups. The instructions for requesting a review are very specific as to whom the applicant should contact, that the request must be in writing, and that the request needs to be received within 15 days after the date the notification was sent to the applicant. The review process — the first review is with the regional community services office, and then, if there is still disagreement, the second review is with the Associate Commissioner of the Division of Developmental Disabilities. Also described are the types of reviews that may occur (in-person interview, teleconference, or just a review of documents) and who can participate with the applicant in the review.
A third page describes the eligibility requirements for the Medicaid Home and Community Based Waiver Programs for individuals with intellectual disabilities.
If the applicant is determined ineligible, the applicant will receive a memorandum regarding the denial of eligibility. This notification will state that the application has been denied specifying the reason why (it will describe the statutory and/or regulatory requirement that has not been met).
The appeal process — begins with a written request from the applicant, either to the Division of Developmental Disabilities or to the Alabama Medicaid Agency, with specific timelines involved for each. If the applicant appeals first to the Division of Developmental Disabilities, he or she will be entitled to a review by the Associate Commissioner, who will produce a written determination. If the individual is dissatisfied with that determination, he/she has the right to appeal to the Alabama Medicaid Agency. The notification fully explains the process of appeal to both agencies. Note: the applicant is not required to appeal first to the Division of Developmental Disabilities but may appeal initially to the Medicaid Agency.