You finally get the news your family has been waiting for: your adult child has been approved for support. You feel relieved. Maybe now you can return to work, build a more predictable routine, and help your child spend more time doing things they enjoy in the community. But there’s still one question you need answered: “When can someone actually start?”
For families seeking home and community-based services, approval and access can be two different milestones. Pennsylvania has recently reported progress in reducing its emergency waiting list for intellectual disability and autism services. At the same time, new national findings show that staffing remains a serious obstacle to delivering support.
Both developments deserve attention. Expanding access means helping people qualify for services and making sure those services can reach them.
Pennsylvania reports progress on its emergency waiting list
On October 30, 2026, the Pennsylvania Department of Human Services announced further reductions in its emergency waiting list for intellectual disability and autism waiver services. The department also reported that five counties had eliminated their emergency waiting lists and that more than 42,000 Pennsylvanians with intellectual disabilities and autism were receiving services at home or in their communities.
DHS credited investments in provider rates and direct support professional wages with helping expand capacity and reduce staff vacancies. [Source: Pennsylvania DHS](https://www.pa.gov/agencies/dhs/newsroom/shapiro-admin-reduces-emergency-waitlist-for-id-a-services-)
That progress matters. Access to support can give a person more choice about daily life and help families plan beyond the next week.
But statewide progress does not tell an individual family when a particular service will begin. That requires a conversation about the person’s needs, their approved plan, and available providers.
Staffing can create another period of waiting
ANCOR’s 2026 direct support workforce survey collected responses from 524 provider organizations operating across all 50 states and Washington, D.C. Among respondents, 85% reported moderate or severe staffing challenges during the previous year. Fifty-five percent were turning away new referrals because of inadequate staffing, and 29% were discontinuing programs or services because of staffing challenges. Source: ANCOR
These are national findings from responding organizations, not Pennsylvania-specific rates. They do not establish how many Pennsylvania families have approved services they cannot use. They do show why workforce capacity belongs in any discussion about expanding access.
The “other waiting list” is a way of describing that potential gap. It is not a separate, official Pennsylvania waiting-list category.
What approval means for your next steps
It helps to separate three questions.
- Is the person eligible? This concerns whether they meet the requirements for the applicable program.
- What services have been authorized? This concerns the support included in the person’s approved plan.
- Who is available to provide those services? This concerns the provider, staffing, schedule, and start date.
An answer to one question does not automatically answer the others. Families should ask which stage they are in and what still needs to happen.
For example, a person might have support authorized for community activities while the provider is still working to fill the requested schedule. The practical issue then becomes how to address the gap and communicate about it.
A missing shift can affect the whole household
Consider a parent who arranges a work schedule around an adult child’s planned support. If that support cannot begin, the parent may have to rearrange work, seek help from relatives, or postpone other responsibilities.
For the person receiving services, a staffing gap might mean missing an activity they chose, losing time to practice a skill, or spending less time with people outside the household.
These examples illustrate why families need clear information about service delivery. A few hours on a schedule can represent something much larger in someone’s life.
The person receiving support should remain central to the conversation. What do they want their week to look like? Which activities and relationships matter to them? What would help them participate in decisions about their support?
How HCBS services support everyday life
The impact of a staffing gap becomes clearer when we look at what the missing support is meant to accomplish. Depending on a person’s assessed needs and authorized plan, services can help with daily routines, relationships, employment, and family caregiving.
HCBS Provider’s services include:
- In-Home and Community Support: Help developing and maintaining skills for daily living, communication, decision making, and community participation.
- Companion Services: Supervision and assistance with everyday activities to support health, safety, and participation at home and in the community.
- Respite Services: Short-term support that gives the person’s usual caregiver a period of relief.
- Behavioral Support: Assessment, individualized strategies, and training for the person receiving services and those supporting them.
- Supported Employment: Assistance with obtaining and maintaining employment, including job coaching and workplace support.
These services address different needs. A family seeking relief from caregiving and an adult seeking help at work may need very different support. The conversation should begin with the individual’s goals and the services appropriate to their plan.
Direct support professionals make access possible
Direct support professionals, often called DSPs, help turn a service plan into everyday support. Depending on the person and the service, that work may include assistance with daily activities, communication, skill development, or participation in the community.
A sustainable response to staffing gaps should include attention to compensation, training, supervision, and working conditions. Providers also need to communicate realistically with families about what they can deliver.
Filling a schedule matters. Building a dependable relationship with someone who understands the individual’s preferences and support needs matters, too.
Questions to ask your supports coordinator
If approved services have not started, or the full schedule is not being delivered, these questions can help make the next conversation more specific:
- What is authorized in the current plan? Ask for clarification about the service, amount, and any conditions.
- What is preventing services from beginning? Ask whether the issue involves staffing, a provider opening, paperwork, or another step.
- Which providers have been contacted? Ask who is following up and whether other qualified providers can be explored.
- Are any appropriate interim options available? Discuss possibilities that fit the person’s preferences, needs, and program rules.
- How should missed services be documented? Keep a dated record of scheduled support, what was delivered, and related communications.
- When will we review the situation again? Agree on a follow-up date and a contact for changes or concerns.
If the person’s needs or the family’s ability to provide support changes, tell the supports coordinator promptly and ask whether the plan needs to be reviewed.
Measuring access through everyday life
Pennsylvania’s reported waiting-list progress is encouraging. Continuing that progress also means paying attention to what happens after a person receives access to a program.
Families need to know when support will start, whether it will be dependable, and whom to contact when something changes. People with disabilities need services that reflect their choices and help them live the lives they want.
A useful question for every discussion about access is: **Is the support in the plan showing up in the person’s life?**
Talk with HCBS Provider about support options
If your family is exploring services or looking for a provider for approved support, contact HCBS Provider to discuss your needs, service options, and current availability. Your supports coordinator can help clarify what is authorized and what steps are needed to arrange services.
A helpful first conversation starts with what matters to the person: the routines they want to build, the places they want to go, and the support they need to participate.