ELIGIBILITY DETERMINATION

The Polk County Developmental Disabilities Program provides case management services to individuals with developmental disabilities. Services provided to individuals can include assessment of support needs, developing an ISP or Annual Plan that may include authorized services, information and referral for services, and monitoring the effectiveness of services and supports.

In order to establish eligibility for services through the Developmental Disabilities Program, the following documents need to be obtained.

1. A completed Request for Eligibility Determination for the Polk County Developmental Disabilities Program.
2. Copies of full reports of any psychological evaluations and IQ tests the applicant has had. (Examples of common IQ tests include: WISC, WAIS, WPPSI, Stanford-Binet and various non-verbal tests).
3. Copies of full reports of any adaptive assessments the applicant has had. (Examples of common adaptive assessments include: Vineland, Adaptive Behavior Assessment System, and Adaptive Behavior Evaluation Scale.)
4. Written documentation signed by a medical doctor or licensed mental health professional verifying the diagnosis of Developmental Disability.

After completing the Request for Eligibility Determination, please contact the Eligibility Specialist at (503) 831-5969, to schedule an intake appointment. Please bring the following items with you to your appointment:

• Completed, unsigned Request for Eligibility Determination
• Any of the above documentation you are able to obtain
• Birth certificate
• Social Security card
• Medical Insurance card (Medicaid, Medicare, private)
• Picture ID (driver's license, OR ID card, school ID, etc.)

Who Is Eligible?

We serve individuals who experience intellectual and developmental disabilities that meet state criteria for eligible diagnosis and level of functioning. The onset of the qualifying condition must be before age 22. Potentially qualifying diagnoses may include intellectual disability, autism, traumatic brain injury, fetal neurological disorders, epilepsy, cerebral palsy, or other conditions whose origin is in the brain. 

How is Eligibility Determined?

1. An individual, a family member or another agency may refer a person for services. To make a referral, call the Polk County Developmental Disabilities Program at (503) 831-5969 and ask for the Eligibility Specialist.
2. The Eligibility Specialist will work with the individual and/or the individual’s representative to gather documentation to determine eligibility. Examples of documentation include:

• Psychological evaluations
• IQ assessment
• Adaptive behavior assessments
• Written documentation by a medical doctor or licensed mental health professional verifying the developmental disability diagnosis.

Once sufficient documentation is available, the individual or individual’s representative will receive a Notice of Eligibility. If the individual is eligible, he or she will be notified who the assigned Services Coordinator will be. If the individual is not eligible, the reason and the method for appealing this determination will be explained in the letter.