by Crystal Welton, J.D., LL.M.
While many individuals with autism are served by the Office of Developmental Program’s intellectual disability programs (ie., Consolidated Waiver and Person/Family Directed Supports Waiver), they are only eligible for these programs because they have both an intellectual disability as well as a diagnosis of autism. However, only a small percentage of people with autism are simultaneously diagnosed with an intellectual disability. Those individuals who have autism but do not have an intellectual disability may not meet the eligibility criteria for the programs above.
For these reasons, it is important for Pennsylvania and its Bureau of Autism Services (BAS) to offer services that do not require IQ as an eligibility factor. One of the primary goals of BAS has been to develop autism-specific programs for adults with Autism Spectrum Disorders (ASD), who are not served by any other system. Currently, Pennsylvania offers two programs for adults with ASD: the Adult Community Autism Program (ACAP) and the Adult Autism Waiver (AAW).
These programs are designed to help adults with ASD remain in the community. Both of these programs are administered at the state level by BAS and do not use IQ as an eligibility factor. Providers for both ACAP and AAW are required to complete autism-specific training and meet certain standards before and after enrolling as a service provider. Moreover, for both programs, services are based upon proven approaches to help individuals realize and achieve their goals as well as measuring success based on an individual’s goals.
The two BAS programs share some of the same eligibility requirements. Specifically, individuals must live in Pennsylvania, be age 21 or older at the time of enrollment, have a diagnosis of ASD, and meet Medical Assistance income eligibility requirements as well as meet the federal definition of functional eligibility. “Functional eligibility” means that an individual must have substantial functional limitations that are likely to continue indefinitely in at least three of the following major life activities:
- Understanding and use of receptive and expressive language;
- Self-direction; and
- Capacity for independent living.
Each program has its own additional requirements that must be met to qualify for both the program and its services.
The AAW, which is available statewide, is a traditional Home and Community Based Services waiver designed to provide long-term services and supports for community living. It is tailored to the specific needs of adults with ASD. This Waiver does permit residential 24/7 care if is determined to be needed through an assessment. Priority for purposes of eligibility is given to adults who are not receiving ongoing state or federally funded services. This Waiver does not provide physical health services; accordingly, participants retain their existing medical insurance.
ACAP is not a waiver. Rather, it is a managed care program that is an integrated model of care that provides physical, behavioral, and community services to adults with ASD. This program becomes the participant’s health plan and all services are provided by one primary provider and their network of providers, including primary care physicians and dentists. At the time of intake, an individual seeking services under this program cannot require sixteen (16) hours or more per week of support while the individual is awake. Currently, this program can serve 200 adults and is offered in Dauphin, Lancaster, Cumberland, and Chester counties.
Both of these programs impose resource limits. Accordingly, an applicant or his/her family may want to consider utilizing a Self-Funded Special Needs Trust for any assets owned by the applicant or a Third-Party Funded Special Needs Trust for any resources received from others (i.e., gifts or inheritances). It is critical to take proper planning steps to insure that the monies of an individual with disabilities (or receipt of monies from others) will not render the individual ineligible for such benefits. Additionally, it is important to contact an attorney to assist with planning regarding these benefits as well as others that may be available, to ensure that your loved one is receiving the maximum benefits, to which he or she may be entitled.