The Developmental Disabilities Administration (DDA) is a subdivision of the Department of Social and Health Services (DSHS) and administers a broad range of programs and Medicaid services for eligible individuals with developmental disabilities in Washington State.  These services and programs may include case management, personal care, respite, employment, community engagement, crisis stabilization services, and residential supports.  The level of support needed by DDA clients to assist them in their daily lives and help them participate in the community varies greatly by individual.

There are two avenues for which functionally and financially eligible individuals may obtain Medicaid paid services in community settings through DDA—the Community First Choice Option (CFCO) of the Medicaid State Plan, and Home and Community Based Services (HCBS) waivers.  The CFCO is an uncapped entitlement and provides personal care to those who qualify for institutional care, but would rather be served in their homes or communities.  The five HCBS waivers allow DDA clients who live in community settings to receive optional services at the same level the individual would receive in an institutional setting.  Unlike the CFCO, each waiver has a capacity limit on the number of people who can be served.

Once determined DDA eligible, a person may or may not choose to request services.  Many people initiate the eligibility process without a current need for services.  This reduces the timeline for accessing future services when needed.  A client is put on the no-paid services caseload once they are found to be eligible for DDA services, but are not receiving paid services.  When the client needs a paid service, they must contact DDA to make a request.  

Prior to 2011, the no-paid services caseload was managed by case managers.  Due to budget reductions, DDA discontinued providing case management services to clients on the no-paid services caseload.  In 2022, the Legislature directed DDA to provided case resource management services to those individuals on the no-paid services caseload. Duties of the case managers for this purpose include:  (1) contacting and responding to the client to discuss the client's service needs, and (2) explaining to the client the service options available through DSHS or other community resources.  As of December 2024, there were 20,231 individuals on the no-paid services caseload.

The bill as referred to committee not considered.

DDA may provide clients on the no-paid services caseload with limited case resource management services.  The case resource manager's duties include responding to the client to discuss the client's service needs and explain to the client the service options available through DSHS or other community resources. Inactive clients on the no-paid services caseload may not receive case resource management services.

PRO: Case management services for the no-paid services caseload was added several years ago, but additional contacts generated by the case managers did not result in appreciable changes to the list. This proposal is included in Governor Inslee's budget.

CON: The no-paid services caseload was never intended to be without a case manager. This has morphed into a holding tank for unserved, newly eligible children. Clients cannot get the services without a case manager. DDA is failing in its role to provide services to those who are eligible. This bill reduces the number of case managers who help to access these services.