Getting on iBudget

Like all HCBS Waivers, the iBudget Waiver caps enrollment which, in Florida, results in a long waiting list. To get on iBudget, you will need to submit an application to APD to determine if you meet clinical eligibility criteria. This typically results in being placed on a waiting list, so it is important to understand how the waiting list is prioritized.

STEPS TO iBUDGET ENROLLMENT

STEP 1: ARE YOU ELIGIBLE?

Clinical eligibility is determined at the initial application. The applicant must be:

  • aged 3 and up, resident and domiciled in Florida,

  • have a “developmental disability” AS DEFINED BY FLORIDA LAW. Florida has its own definitions for the 7 eligible diagnoses: intellectual disability, autism, cerebral palsy, spina bifida, Down syndrome, Prader-Willi syndrome, and Phelan-McDermid syndrome.

  • meet an ICF level of care.

Financial eligibility is determined just prior to enrollment, but it is typically not an issue because it is based on the income and assets of the applicant, not the household, even if the applicant is a child.

STEP 2: FILL OUT AN APPLICATION AND SUBMIT TO APD

Application forms are available on APD’s website. Currently these must be filed out and submitted to the APD Regional Office in the area where the applicant resides.

APD is primarily interested in whether or not the applicant has a developmental disability that qualifies for iBudget (See STEP 1). While other conditions may impact functionality and care needs, it is the nature of the developmental disability that sets this program apart from the other Florida HCBS Waiver, the LTC Waiver.

STEP 3: DOCUMENTING ELIGIBILITY

You will need to provide APD with documents that show you meet the eligibility criteria. What you provide depends on which developmental disability you have been diagnosed with. To document Down syndrome, for instance, you may need a letter from your physician stating that you have this diagnosis. For intellectual disability or autism, APD may ask for psychological evaluations over time, school records (particularly IEPs), and other reports.

If you cannot provide any evaluations or if APD believes the evaluations you submit are inaccurate, incorrect or incomplete, the APD Regional Office is responsible for obtaining an appropriate evaluation.

STEP 4: CHALLENGING A DETERMINATION OF INELIGIBILITY

You have the right to ask for an administrative fair hearing if you receive a notice that you are not eligible for iBudget. READ THE NOTICE. APD may need more documentation or may misunderstand the documentation provided. The Notice will give you specific instructions on where to send your request for fair hearing, what information to include, and the time you have to make that request.

Fair hearings are held before hearing officers at DCF Office of Appeal Hearings. Both parties - you and APD - can put on testimony and submit evidence at the hearing, which is usually by phone or video conferencing. In-person hearings can also be requested. You do not need to be represented by an attorney but can chose to have someone speak on your behalf.

Unfortunately, eligibility hearings tend to be among the most complex because they typically involve arguments about either psychological testing and diagnosis or legal interpretations of agency rules, or both.

STEP 5: UNDERSTANDING WAITING LIST PRIORITIES

Unless you are seeking to transition from an ICF, you will be given a waiting list (aka “pre-enrollment list”) priority category. These are defined by statute and are set out below from highest to lowest priority:

  1. Client in Crisis. See STEP 6 for definition.

  2. Client transitioning out of child welfare system

  3. A mishmash of criteria, including a caregiver with a condition that will likely prevent care in the next year, a client at substantial risk of jail, a client transitioning from a nursing home or state mental hospital with no available caregiver, and a client whose behaviors or physical needs place them or caregivers at risk of harm

  4. Clients with a caregiver age 70 or over (and no alternate caregivers)

  5. Clients expected to graduate within a year and need a meaningful day active or supported employment

  6. Clients not in another category and 21 or over

  7. Clients not in another category and under 21

    Within categories, the ranking is based on date the client was determined eligible for the waiver.

STEP 6: CRISIS PRIORITY ENROLLMENT REQUEST

Crisis Priority is the way most people get off the waiting list. Crisis is defined by Rule 65G-1.047, Fla. Admin. Code and the determination process is set out in Rule 65G-11.004. Requests for crisis enrollment are made to the APD Regional Office where the client resides and may be oral or written. APD staff are assigned to help you with the process.

If your crisis request is denied, you have the right to request a fair hearing. You can also wait and make another request, particularly if the situation worsens.

There are three categories of crisis priority:

  1. Client is currently homeless or living with relatives in an unsafe environment

  2. Client has behaviors that may create a life-threatening situation or result in bodily harm to self or others

  3. Client’s current caregiver is in extreme duress due to injury, illness, or advanced age

    The rule includes a list of factors under each category that would be indicators of a crisis. The list is not exclusive and is not intended to be a checklist.

    Even if these circumstances are met, if the crisis could be averted by accessing services from another source, APD will deny the request.