Medicaid, called Medical Assistance in Pennsylvania, is a public health insurance program run by the state with help from the federal government. Medicaid is the most significant health care program in the country and is an essential part of the United States healthcare system. However, it can be challenging to understand and navigate, and finding applicable information or applying for Medicaid programs can be confusing.
What is a Medicaid Waiver?
A Medicaid Waiver is a program offered through Medicaid that helps provide services to specific groups of people who would otherwise be in an institution, nursing home, or hospital. These services allow them to receive long-term care in the community. While each state creates and runs its own Medicaid Waiver programs, the federal government has to approve them. In Pennsylvania, Medicaid Waivers are meant to serve people in their homes and communities. Many people with disabilities need home and community-based services to be able to live independently. The Pennsylvania Department of Human Services (DHS) handles Medicaid Waivers for our state. To see if you qualify for services, visit your local County Assistance Office. Here is a list of local offices from the DHS website: Local Offices
Why is it called a Waiver?
These programs allow the federal government to “waive” Medical Assistance/Medicaid rules in order for states to use funds to provide support services. Waivers often cover services that are not paid for by traditional Medicaid, such as employment and community support. In Pennsylvania, it’s essential to know what waivers are available.
What Waivers are Available in Pennsylvania?
Waivers available in Pennsylvania include:
- Consolidated Waiver
- Person/Family Directed Support Waiver
- Serves people with intellectual disabilities
- Offers adaptive appliances and equipment; Home and Community Habilitation; personal support services; prevocational services; therapies (physical therapy, occupational therapy, speech, visual/mobility, and behavioral); licensed day habilitation; homemaker/chore services; respite care; supported employment; visiting nurse; transportation; support coordination; home modification; and transitional work services.
- Attendant Care Waiver – serves people with physical disabilities
- HCBW for Individuals Aged 60 and Over
- AIDS Waiver
- COMMCARE Waiver
- Independence Waiver – helps people with physical disabilities
- Medicaid Waiver – for infants, toddlers, and families
- Adult Autism Waiver
Each Waiver has different eligibility requirements, offers various services, and has different benefits and restrictions. However, they are all meant to help people live independently in their homes and communities. All of these waivers run through Pennsylvania’s Office of Developmental Programs (ODP).
Check out the DHS website for more information on the available wavers. DHS Wavier
Who Can Get Medicaid Waivers?
Each state determines what group of people can get a Medicaid Waiver and what services they can obtain from the waiver. Most Medicaid Waivers are for adults over 65, people with specific disabilities, or people with long term illnesses. The state of Pennsylvania defines a developmental disability as a severe, ongoing disability which occurs before the age of 22, affects an individual’s physical and/or mental ability, limits an individual’s ability to perform daily activities such as self-care, communication, learning, mobility, independent living, daily decision making, and work, and requires an individual to have continuing support in order to accomplish tasks and achieve life goals.
Are There Income Limits?
Financial eligibility for waiver programs in Pennsylvania requires that individuals have an income level below $2,022 per month and resources below $8,000 (including savings accounts and investments).
Is There an Age Requirement?
In Pennsylvania, different Waiver programs have different age requirements. For example, the Person/Family Directed Support Waiver serves individuals age thee and older with intellectual disabilities, while the Independence Waiver serves individuals 18 and over with physical disabilities that will likely continue indefinitely. The Attendant Care Waiver serves individuals between the ages of 18 and 59 who have a physical impairment expected to last at least 12 months, and the Autism Waiver serves individuals who are 21 and older with a diagnosis of Autism Spectrum Disorder.
How Can These Services be Obtained?
Each waiver has its own unique set of eligibility requirements and services. In Pennsylvania, the Department of Public Welfare administers multiple Medical Assistance/Medicaid waivers. To obtain a Medicaid Waiver, a person must show that they need support to live and work in the community. The state will then conduct an assessment to determine how much support the individual requires, which will determine if the person is eligible for a Medicaid Waiver. The Waiver participant can then choose a provider.