Pennsylvania’s Waiver Program
By Crystal L. Welton
In addition to Medical Assistance, the Department of Public Welfare also provides the Medicaid Home and Community Based Waiver Program, which is also known as the Support Services Waiver program or simply the Waiver program. The Waiver program provides funding for supports and services to help individuals with disabilities live in their home and communities, rather than in an institutional setting. The name of the program, Waiver, derives from the federal government “waiving” the Medical Assistance requirement that an individual require institutional care, permitting Pennsylvania’s Department of Public Welfare to use the same funds allocated for Medical Assistance to provide supports and services for individuals in their own communities.
The Department of Public Welfare administers several Waiver programs as well as the Living Independence for the Elderly (“LIFE”) Program. Each waiver has its own eligibility requirements, including but not limited to income, resource, age, and level of care requirements, and its own specific set of services it provides. Some of the Waiver programs provided by the Department of Public Welfare, including the LIFE program, with a brief description, are as follows:
- Aging Waiver (PDA Waiver) – Provides long-term care services to qualified older Pennsylvanians living in their homes and communities.
- AIDS Waiver – Provides home and community based services to eligible individuals, who are at least 21 years old and who have symptomatic HIV Disease or AIDS.
- Attendant Care / Act 150 – The Attendant Care Waiver provides home and community based services to individuals with physical disabilities, allowing individuals to remain as independent as possible. The Act 150 program provides the same type and amount of services as the Attendant Care Waiver; however, it does not have the same eligibility requirements as the Waiver.
- Autism Waiver – Provides supports for adults, who are at least 21 years old, with Autism.
- COMMCARE Waiver – home and community based program created for individuals who experience a medically determinable diagnosis of traumatic brain injury.
- Consolidated Waiver for Individuals with Intellectual Disabilities – Provides home and community based services to eligible individuals with intellectual disabilities.
- Independence Waiver – Provides services to eligible persons with physical disabilities.
- Infant, Toddlers, and Families Waiver – Provides services to children from birth to age 3 in need of Early Intervention services who would otherwise require the level of care provided at an Intermediate Care Facility.
- LIFE (Living Independence for the Elderly) – Provides comprehensive health care and supportive services and is designed as an alternative to nursing facility care for persons that reside in an area served by a LIFE provider.
- OBRA Waiver – Provides services to individuals with severe developmental physical disabilities, such as cerebral palsy, epilepsy or similar conditions.
- Person/Family Directed Support Waiver / Consolidated Waiver – Provides services for individuals with a diagnosis of intellectual disability (formerly known as mental retardation).
- Consolidated Waiver – Provides services for individuals with a diagnosis of intellectual disability (formerly known as mental retardation).
The services provided by these various programs, which could include services such as skilled nursing coverage, personal care assistance services, and home modifications, are not generally covered by Medical Assistance, especially on a long-term basis. The services available differ depending on the specific Waiver program and the service plan developed to address an individual’s specific needs. Individuals that qualify for, and receive services through, a Waiver program will continue to receive full benefits through Medical Assistance.
Unlike Medical Assistance, the Waiver programs are not entitlement programs and have limited capacity and limited funding. There is no guarantee that an individual will receive waiver benefits even if he meets all of the eligibility requirements for that Waiver; moreover, some of the Waiver programs have waiting lists. For that reason, you should be proactive in determining whether your loved one can qualify for, and benefit from, a Waiver program.
If you believe your loved one can benefit from the home and community based services provided by one of these Waiver programs, please contact our office to schedule an appointment to discuss the eligibility requirements and services available as well as the application process.