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Waiver Process
Home and Community-Based Services (HCBS) Waiver Programs are available in Pennsylvania to provide supportive services to qualified individuals who wish to remain in their homes and communities rather than enter a nursing home or intermediate care facility.
Waiver programs provide long-term care and support to individuals at risk for institutionalization but who wish to remain living in their homes. The programs provide medical and non-medical services at home and other community-based settings in order to help people remain living independently. These Waiver services are not typically covered under Medicare or Medicaid, particularly on a long-term basis.
Waiver services include skilled nursing coverage, personal care assistance, and home modifications. Available services differ depending on the Waiver program the person may qualify for, and the service plan that is developed to address their individual needs.
The following Waiver programs are available in Southwestern Pennsylvania for adults with physical and developmental disabilities:
To qualify for the Aging Waiver one must be a resident of Pennsylvania, be a U.S. citizen or a qualified Non-citizen, have a Social Security Number, be 60 years of age or older, and meet the level of care needs for a Skilled Nursing Facility
To qualify for the Attendant Care or ACT 150 Waiver one must be 18-59 years of age, have a physical impairment expected to last at least 12 months or cause death, be capable of: selecting, supervising and, if needed, firing an attendant, managing one’s own financial/legal affairs, due to physical impairment(s), require assistance to complete functions of daily living, self-care and mobility, be a resident of Pennsylvania, and be a permanent resident/citizen of US.
To qualify for the COMMCARE Waiver one must: be a Pennsylvania resident, be 21 years of age or older, have a medically determinable diagnosis of traumatic brain injury and require a Nursing Facility (NF) level of care
To qualify for the Independence Waiver one must have a long-term physical disability, be a PA resident, be 18-60 – Individuals that turn 60 while in the waiver will be able to continue to receive services through the Independence Waiver, be assessed to require services at the level of nursing facility level of care, have a disability that results in substantial functional limitations in three or more of the following major life activities: Self-care, understanding and use of language.
To qualify for the OBRA Care Waiver one must: be a resident of Pennsylvania, be 18-59 years of age, have a severe developmental physical disability requiring an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care. Other related conditions (ORCs) include physical, sensory, or neurological disabilities which manifested before age 22 and are likely to continue indefinitely. The disability must result in substantial functional limitations in three or more of the following major life activities: Self-care, communication, learning, mobility, self-direction and capacity for independent living.
Other Waivers that are available to adults in PA include two Waivers for adults with Intellectual Disabilities: Consolidated Waiver and Person/Family Directed Support Waiver.
In general, individuals contact a specific agency to start the Waiver application process. There are several steps in the Waiver application process:
In-person assessment is made to determine whether someone meets the level of care requirements and other functional criteria. As part of the assessment process, the individual’s physician completes paperwork to certify the level of care needed. Once the above steps are completed the application is sent to the County Assistance Office (CAO). The CAO reviews the person’s income and resources to see if they qualify financially for the Waiver program.
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