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Articles

DDS Application and Appeals Process: Getting to Eligibility

By Patrick C. Tinsley on November 13, 2020
The parents and guardians of children with intellectual or developmental disabilities face numerous challenges, not the least of which is navigating the process of obtaining support services from the Department of Developmental Services (DDS). This article provides a brief summary of the steps in that process and some suggested tips that can enhance your chances of success.

DDS is part of the Executive Office of Health and Human Services, the most expansive agency in the commonwealth of Massachusetts. DDS provides a range of services for individuals with intellectual and developmental disabilities. Since no two people have exactly the same needs, DDS tailors its services to each individual’s unique circumstances. But broadly speaking, DDS services include employment, day program and residential supports for qualified adults, and family support and specialized educational services for qualified children. To apply for services, an applicant – or more typically -- the applicant’s parents or guardians fill out and submit the Application for DDS Eligibility form, which can be found on the DDS website. Completed applications must include the following documentation:
  • Birth certificate
  • Social Security card
  • Health insurance card(s) (e.g., MassHealth, Medicare, private insurance)
  • Medical reports documenting the diagnosis underlying the applicant’s need for DDS services (e.g., Closely Related Developmental Condition, Intellectual Disability, Autism Spectrum Disorder, Prader-Willi Syndrome, Smith Magenis Syndrome)
  • A Notice of Privacy Practices Acknowledgement Form
  • Proof of Massachusetts domicile (e.g., a Massachusetts driver’s license, a Massachusetts ID card, a utility bill with the applicant’s name and Massachusetts address).
Most of the required documentation is straightforward, but “proof of Massachusetts domicile” requires some explanation. The concept of “domicile” may be obscure and unfamiliar to some applicants, but it is important to understand because domicile is often the first issue that DDS examines when reviewing an application. If DDS finds that an applicant is not domiciled in Massachusetts, it will deny eligibility on that basis alone and will not proceed to evaluate the application further. Successfully applying for DDS services, therefore, requires an understanding of how to prove that the applicant is domiciled in Massachusetts.

Domicile refers to a person’s primary residence – the place where he or she resides and intends to remain for an indefinite period of time. For applicants who are lifelong residents of Massachusetts or whose parents make Massachusetts their permanent home, proof of domicile is usually easy to obtain. Such applicants typically establish that they are domiciled in Massachusetts by producing a state-issued license or ID card, a library card, a bank statement or utility bill showing a Massachusetts address, or other similar documentation. But for applicants who moved to Massachusetts from out of state, and whose parents or guardians reside out of state, DDS may not accept that as proof of domicile.

For example, there are children (and adults) whose out-of-state parents have arranged for them to live in a group home, specialized school or other assisted-living facility in the commonwealth. When DDS reviews applications from people in those or similar circumstances, the agency presumes that the applicant is not domiciled in Massachusetts. That presumption can be rebutted, but in many instances the customary proof of domicile – state-issued licenses or ID cards or other official documents bearing the applicant’s Massachusetts address – will not suffice. For that reason, applicants who have questions about how DDS may view their domicile status should consider speaking with an attorney who is familiar with DDS regulations.

Applicants who are determined ineligible – whether because of domicile or for any other reason – have a right of appeal, but the applicant must take quick and appropriate action to preserve that right. Applicants must send notices of appeal in writing, within 30 days of receiving the decision, to the regional director for the department region in which the applicant resides.

The first step in the DDS appeal process is for the regional director to convene the “informal conference.” As the name suggests, the informal conference does not take place in a structured setting and is not an adversarial process. Instead, it is an opportunity for the applicant – and/or parents and guardians – to meet with the regional director and other members of the regional eligibility team to discuss the reasons why DDS rejected the application. The conversation can be difficult at times. Applicants are often dissatisfied with the reasoning that led DDS to deny their eligibility. Parents are often weary from years of unceasing advocacy on behalf of their special-needs children and frustrated by the defeats, denials and indignities they and their family have endured along the way. But as difficult as the conversation may be, it is an invaluable opportunity to engage with DDS on a personal level – in an informal, face-to-face conversation with the relevant decision-makers – and collaborate on possible ways to remedy any deficiency in the application. Applicants who may take a jaded view of DDS as staffed by uncaring bureaucrats are often surprised to see how passionate those bureaucrats are about promoting the well-being of the intellectually and developmentally disabled. It is not unusual for DDS to provide constructive feedback that can help an applicant cure any deficiencies in the application and obtain eligibility for services.

If the applicant is not satisfied with the outcome of the informal conference, he or she may request a fair hearing. Once again, this must be done in writing and within 30 days. A fair hearing resembles a trial in civil court, with each side presenting evidence, eliciting testimony from witnesses and arguing their position. When the fair hearing is concluded, the hearing officer, whose role is similar to that of a judge, will issue a written decision outlining his or her findings of fact and conclusions of law. Applicants are entitled to have a lawyer represent them at the fair hearing and are encouraged to seek out qualified counsel. Even the most sophisticated and savvy applicants who are deeply familiar with the relevant medical and legal standards that govern their situation may find themselves unable to present their case effectively under trial conditions.

The key takeaways are that it is important to understand the DDS application process and its requirements, and that appeals can be made after a denial but must be requested promptly and in writing.


©2020. This material is intended to offer general information to clients and potential clients of the firm, which information is current to the best of our knowledge on the date indicated below. The information is general and should not be treated as specific legal advice applicable to a particular situation. Fletcher Tilton PC assumes no responsibility for any individual’s reliance on the information disseminated unless, of course, that reliance is as a result of the firm’s specific recommendation made to a client as part of our representation of the client. Please note that changes in the law occur and that information contained herein may need to be reverified from time to time to ensure it is still current. This information was last updated November 2020.

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