Waivers for Individuals with Intellectual Disabilities
By Crystal L. Welton, J.D., LL.M.
McAndrews Law Offices, P.C.
30 Cassatt Avenue
Berwyn, PA 19312
In addition to Medical Assistance, the Department of Public Welfare 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 continue to live in their homes and communities, rather than in institutional settings. 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. Each Waiver also has its own specific set of provided services.
There are two Waivers for individuals with intellectual disabilities: the Consolidated Waiver and the Person/Family Directed Supports (P/FDS) Waiver. To be eligible for either of these Waivers, one must meet the following requirements:
- Have a diagnosis of intellectual disability;
- Need the same level of care provided in an Intermediate Care Facility for People with an Intellectual Disability;
- Need active treatment; and
- Meet the income and resource limits.
The P/FDS Waiver is known as the “small” Waiver because it provides up to $30,000 per person each year, which is used to get support to participate in activities in the community. The activities will be determined after creating an Individualized Support Plan (ISP), which outlines the supports and services necessary, with the Supports Coordinator; however, it cannot pay for residential care.
The Consolidated Waiver, which is also referred to as the “big” Waiver, the residential Waiver, or the 2176 Waiver, does not place a cap on an individual’s budget to purchase necessary supports. The amount of support is based upon an individual’s assessed needs, as determined through the planning process and outlined in an individual’s ISP. The Consolidated Waiver can provide the same supports available through the P/FDS Waiver but could also include out-of-home residential care in the community.
The P/FDS Waiver and the Consolidated Waiver provide supports and services, including, but not limited to, supports coordination, companion services, homemaker/chore services, assistive technology, specialized supplies, licensed day habilitation, supported employment, transitional work services, prevocational work services, home accessibility adaptations, vehicle accessibility adaptations, transportation, physical therapy, occupational therapy, speech/language therapy, nursing services, behavioral therapy and support, respite services, and educational support services. The Consolidated Waiver offers two services, which are not available through the P/FDS Waiver: licensed residential habilitation and unlicensed residential habilitation.
Unlike Medical Assistance, the Waiver programs are not entitlement programs and all of the Waiver programs, including those for individuals with intellectual disabilities, 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, which currently exceed 14,000 known individuals. 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 either of these Waivers for individuals with intellectual disabilities or any of the other Waivers, please contact our office to schedule an appointment to discuss the eligibility requirements and services available as well as the application process.