Massachusetts DDS Priority Levels and the MASSCAP Assessment

How DDS Decides Who Gets Services First

When your family member is found eligible for DDS adult services, that eligibility does not come with a funded placement. Massachusetts DDS assigns each eligible individual a priority level that determines when — and whether — funded services become available.

This is the hardest part of the adult transition for families to accept: the school system operated on entitlement (your child was legally owed services), but the adult system operates on priority and appropriation (services are rationed based on need and budget).

The Three Priority Tiers

Priority 1 — Emergency/Crisis. Reserved for individuals in immediate danger. Qualifying situations include homelessness or imminent loss of housing, active abuse or neglect, the sudden death or medical incapacitation of the primary caregiver, or a behavioral or medical crisis that cannot be safely managed in the current setting. Priority 1 cases are funded with reasonable promptness, but that does not guarantee a particular placement.

Priority 2 — Substantial Need. Applied to individuals with significant functional limitations who need adult services but whose current situation is stable. The typical Priority 2 case is a young adult living with aging parents who provides adequate care now but will not be able to indefinitely. Priority 2 individuals are placed on a waitlist and funded as legislative appropriations or vacant waiver slots become available. Wait times can extend for years.

No Priority. The individual is eligible for DDS services but does not currently meet the criteria for either priority tier. Funding for these cases comes only when surplus capacity exists, which is rare.

What the MASSCAP Assessment Measures

The Massachusetts Comprehensive Assessment Process (MASSCAP) is the standardized evaluation DDS uses to determine an individual's support needs and inform priority decisions. MASSCAP includes the Inventory for Client and Agency Planning (ICAP), which measures adaptive behavior and functional independence across multiple domains.

The assessment covers:

• Daily living skills (eating, dressing, hygiene, household tasks)
• Social and communication skills
• Community integration capacity
• Behavioral concerns and safety risks
• Medical complexity and health-related support needs

MASSCAP results directly influence which services are recommended and at what intensity. A higher assessed need for support strengthens the case for a higher priority tier and a more intensive waiver (Community Living or Intensive Supports rather than Adult Supports).

The SIS-A: A Newer Assessment Tool

DDS has integrated the Supports Intensity Scale for Adults (SIS-A), developed by the American Association on Intellectual and Developmental Disabilities, into its assessment toolkit. The SIS-A takes a different approach than traditional adaptive behavior scales — rather than measuring what the individual can do, it measures what support the individual needs to participate in daily activities.

The SIS-A evaluates support needs across:

• Home living activities
• Community living activities
• Lifelong learning
• Employment
• Health and safety
• Social activities
• Protection and advocacy needs

The SIS-A produces a composite support needs index that helps DDS match individuals to appropriate service models. A high SIS-A score indicates the individual requires frequent, intensive support — relevant evidence when requesting a higher priority level or a more intensive HCBS waiver tier.

How to Prepare for the Assessment

The MASSCAP and SIS-A assessments are conducted by DDS-trained evaluators, often at the family's home or the DDS area office. Preparation matters because the snapshot captured during the assessment drives service recommendations.

Before the assessment:

• Document worst-case scenarios, not best days. Assessors need to understand the level of support required when things go wrong, not when everything runs smoothly.
• Bring written examples of behavioral incidents, medical emergencies, or daily tasks that require hands-on assistance.
• Ask the individual's medical team or therapist to provide a letter describing support needs from a clinical perspective.
• If the individual performs better in structured settings (like school) than unstructured ones (like home on weekends), explain this discrepancy to the evaluator.

Requesting a Priority Reassessment

Priority levels are not permanent. If your family member's circumstances change — a caregiver's health declines, behavioral needs escalate, housing becomes unstable — you can request a priority reassessment through your DDS service coordinator.

The request should include updated clinical documentation, incident reports, and any evidence that the current living situation has become unsafe or unsustainable. Priority 1 cases are funded with reasonable promptness, while Priority 2 cases can wait years for funded services.

The Massachusetts SSI at 18 & Adult Disability Benefits Guide includes a meeting preparation sheet specifically designed for DDS assessments, helping families organize the clinical evidence and functional examples that assessors need to see.

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