Who are the relevant state entities?
The Division of Developmental Disabilities (“DDD”) operates under the Arizona Department of Economic Security (“ADES”). The DDD provides services to qualifying Arizona children with developmental disabilities. The Arizona Long Term Care System (“ALTCS”) is Arizona’s Medicaid program that provides long-term care services to DDD members. ALTCS operates under the Arizona Health Care Cost Containment System (“AHCCCS”).
Eligibility requirements for children with ASD differ based on the child’s age.
Autism spectrum disorder (“ASD”) is a developmental disability. Children with ASD may be eligible for state funded services through the ADES and the DDD, depending on whether they meet certain eligibility requirements. Eligibility requirements for children with ASD differ based on the child’s age. The ADES revaluates the eligibility of children receiving DDD services every six months.
- Eligibility for Children under Six
Children under six with an ASD diagnosis are eligible for DDD services. Children are eligible for DDD services if they have a delay in at least one area of development. Children at risk of developing a developmental disability are also eligible for DDD services. To qualify for services, children under six must be evaluated by a licensed physician, psychologist, or other individual formally trained in early childhood development.
- Eligibility for Children Six and Over
Eligibility requirements change for children six and over. Children six and over are eligible for DDD services if they have substantial functional limitations (“SFL”) in at least three areas of major life activities. There are seven areas of major life activities that the ADES considers when determining eligibility. SFLs manifest in different ways depending on major life activities being considered. The seven areas of major life activities are listed below:
- Self-care: This refers to a child’s ability to perform personal health and hygiene activities. Children who need enough assistance or extra time to perform self-care that their other daily activities are impeded have an SFL.
- Receptive and expressive language: This refers to a child’s ability to understand language and communicate needs. Children who cannot communicate with others, or must use augmentative and alternate communication devices, have an SFL.
- Learning: This refers to a child’s ability to “acquire, retain, and apply information and skills.” Children who cannot “participate in age-appropriate learning activities without . . . additional resources” have an SFL. 
- Mobility: This refers to a child’s ability to move safely between locations. Children who require assistance moving or must expend enough effort to impede other daily living activities have an SFL.
- Self-direction: This refers to a child’s ability to manage her own life, including goal setting, managing finances, and preventing self-injury. Children who will not be capable of managing personal finances, protecting their self-interests, or making independent decisions have an SFL.
- Capacity for independent living: This refers to a child’s ability to complete daily tasks for home living, including grocery shopping and chores. Children who require daily assistance in completing these tasks have an SFL.
- Economic self-sufficiency: This refers to a child’s ability to become employed. Children who will not be able to earn an income above the federal poverty level have an SFL.
The last three areas of major life activity–self-direction, capacity for independent living, and economic self-sufficiency–are assessed by comparing a child’s behavior to age-appropriate guidelines issued by the Centers for Disease Control and Prevention and the American Academy of Pediatrics. If a child six or over has at least three SFLs in the above areas, that child is eligible for DDD benefits.
- Losing DDD Benefits Because Your Child Does Not Have Three SFLs
Children who receive DDD benefits before age six may lose those benefits after their sixth birthday if they do not have three SFLs. Families should be aware that it is the ADES’s burden to show that a child receiving DDD services does not have three SFLs. In recent years, courts have forced the ADES to reinstate children’s DDD services after the ADES could not affirmatively prove that the children did not have three SFLs. For more information, check out our blog post “Arizona Autism Litigation News.”
Are there any other state programs or federal laws I should be aware of?
Yes! ALTCS is the State of Arizona’s Medicaid program that provides long-term care services, at little or no cost, to financially and medically eligible Arizona residents who have a developmental disability. Once a person has been determined financially eligible, medical eligibility must be established. To meet medical requirements, an individual must need a level of care necessary for, at a minimum, an intermediate care facility. Once a child is over 3 years old, approval for funding through ALTCS is necessary to receive DDD and/or behavioral health services such as habilitation, respite, attendant care, speech therapy, or Applied Behavior Analysis.
Between birth and three years old, the Arizona Early Intervention Program (AzEIP) provides important services. AzEIP is Arizona’s statewide interagency system of services and supports for families of infants and toddlers, birth to three years of age, with disabilities or delays. AzEIP is established by Part C of the Individuals with Disabilities Education Act (IDEA), which provides eligible children and their families access to services to enhance the capacity of families and caregivers to support the child’s development.
From the standpoint of group health insurance benefits, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (also known as the Federal Parity Act or MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. You can read more about the Federal Parity Act on our blog here .
Another law in the mix is the Employee Retirement Income Security Act (ERISA). Self-funded health benefit plans are regulated by ERISA and other federal laws. Self-funded health benefit plans are not subject to state autism insurance laws like Steven’s Law (you can read more about Steven’s Law on our blog here). You can read more about how ERISA is shaping the behavioral health landscape on our blog here.
Knowing how the ADES determines eligibility for DDD and ALTCS services can help ensure that families receive the services to which they are entitled. Dickinson Wright knows how to help families and providers navigate DDD and ALTCS services, the Federal Parity Act, and ERISA, and is ready to assist children with ASD.
 Developmental Disabilities, Arizona Department of Economic Security, https://des.az.gov/services/disabilities/developmental-disabilities.
 A.R.S. § 36-551(19)(a).
 Available DDD Services & Supports, Arizona Department of Economic Security, https://des.az.gov/services/disabilities/developmental-disabilities/individuals-and-families/supports-and-services See also, A.A.C. R6-6-302(A).
 A.A.C R6-6-302(G), (H).
 A.R.S. § 36-565(A).
 A.A.C. R6‑6‑302(G)(2)(a).
 A.A.C. R6‑6‑302(G)(2)(c).
 A.A.C. R6‑6‑302(G)(2)(b).
 A.A.C. R6‑6‑302(G)(3).
 A.A.C. R6-6-302(H).
 A.A.C. R6-6-303(C)(1)‑(7).
 A.A.C. R6‑6‑303(C)(1).
 A.A.C. R6-6-303(C)(2).
 A.A.C. R6-6-303(C)(3).
 A.A.C. R6-6-303(C)(4).
 A.A.C. R6-6-303(C)(5).
 A.A.C. R6-6-303(C)(6).
 A.A.C. R6-6-303(C)(7).
 A.A.C. R6-6-303(C)(5)–(7).
 A.A.C. R6-6-302(H).
 See A.A.C. R6-6-302(H); see also, e.g., A.C. v. Ariz. Dep’t of Econ. Sec., 249 Ariz. 387, 389–90, 470 P.3d 661, 663–64 (App. 2020); J.R. v. Ariz. Dep’t of Econ. Sec., No. 1 CA-UB 19-0093, 2020 WL 5803292, *1 (App. May 4, 2021).
 A.C., 249 Ariz. at 393, 470 P.3d at 667.
 See, e.g., A.C., 249 Ariz. at 393–94, 470 P.3d at 667–68; J.R., 2020 WL 5803292 at *3; A.W. v. Ariz. Dep’t of Econ. Sec., 247 Ariz. 249, 255, 448 P.3d 290, 296 (App. 2019).
 Once eligibility is established, the individual is enrolled with a Program Contractor and assigned to a case manager. The case manager meets with the family in order to develop a service plan. Covered services may include: Institutional; Home and Community Based Services, combining out-patient and in-home care; Medical Services, such as a visit to the doctor’s office; Behavioral health services; Preventive and well care; and Hospice services. See https://www.azahcccs.gov/Members/Downloads/Publications/DE-828_english.pdf for more information.
 You can read more about AzEIP here: https://des.az.gov/services/disabilities/developmental-infant.
 The Mental Health Parity and Addiction Equity Act (MHPAEA), Centers for Medicare & Medicaid Services, https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet
Health Care Law, Behavioral Health Care Law
ABOUT THE AUTHORS
Emma Trivax is an associate in Dickinson Wright’s Troy office. She can be reached at 248-631-2098 or email@example.com. Her biography can be accessed here.
Erica Erman is an associate in Dickinson Wright’s Phoenix office. She can be reached at 602-889-5342 or firstname.lastname@example.org. Her biography can be accessed here.
Gregory Moore is a Member in Dickinson Wright’s Troy office. He can be reached at 248-433-7268 or email@example.com. His biography can be accessed here.
Noah Goldenberg is a summer associate in Dickinson Wright’s Phoenix office.