How Do I Apply?


A potential participant or an individual acting on his/her behalf contacts the RRDC in the region where he/she chooses to reside or where they are currently living. The RRDS completes the Referral form (refer to Appendix B) and makes a determination whether to proceed to the Intake process. If the individual is considered not to meet the basic criteria for the waiver or indicates his/her preference not to pursue admission into the NHTD waiver, the RRDS will provide available options for referrals to other programs/services.

Note: It is expected that within two (2) weeks of receiving the referral the RRDS will make contact with the individual and schedule an Intake. If it is immediately apparent that the Referral will not proceed to Intake (e.g. the individual is under age 18), the RRDS has two (2) business days to contact the individual and give them information for other community resources.


If the potential participant has a Legal Guardian the RRDS will request a copy of the Guardianship document be provided at the time of Intake. The RRDS meets with the potential participant, his/her Legal Guardian, if applicable and anyone the potential participant chooses to be present and describes the waiver philosophy and available services.

The RRDS provides the potential participant with a list of approved Service Coordination providers and encourages him/her to interview potential Service Coordinators.

The potential participant selects a Service Coordination Agency from the list of approved providers, completes the Service Coordinator Selection form (refer to Appendix B – form B.5) and returns it to the RRDS. The RRDS forwards the Service Coordinator Selection form to the selected Service Coordinator provider for their signature along with a copy of the Intake form.


It is at this point the individual becomes a formal applicant. The applicant and anyone he/she may choose, works with their chosen Service Coordinator to develop an ISP (refer to Appendix C – form C.1) and PPO. This process includes the applicant and Service Coordinator working together to develop the ISP and PPO. The Service Coordinator assembles the Application Packet, which includes the following forms:

  • Application for Participation - completed with the RRDS
  • Participant Rights and Responsibilities
  • H/C PRI and SCREEN
  • Initial Service Plan (ISP) - including Medicaid coverage Verification (Medicaid Eligibility Verification System)
  • Provider Selection form(s)
  • Insurance, Resource and Funding Information Sheet;
  • Plan of Protective Oversight (PPO)
  • Proof of physical disability determination (if under age 65)
  • Freedom of Choice - completed with the RRDS
  • Service Coordination Selection - completed with the RRDS

The Service Coordinator sends his/her part of the completed Application Packet to the RRDS which includes Participant Rights and Responsibilities, H/C PRI and SCREEN , PPO, Initial Service Plan, Provider Selection forms, Insurance, Resource and Funding Information Sheet, Proof of disability determination (if under age 65) (refer to Section V - The Service Plan).

Then a determination is made by the RRDS. As your Service Coordinators, we are with you every step of the way!

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