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:
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.
To be eligible for any Waiver program, individuals must meet functional criteria and financial criteria.
Functional eligibility means a certain level of care requirements specified by the individual programs. Generally, a person will have to need the services of a Nursing Facility, Intermediate Care Facility for the Mentally Retarded, or Intermediate Care Facility for Other Related Conditions in order to qualify for a Waiver program. An assessment to determine the level of need is made and a doctor completes a physical certification form to establish the care required. Each Waiver program has additional functional criteria beyond the level of care that an individual must meet in order to qualify.
Financial Criteria is determined by income (an applicant must have income below 300% of the federal benefit rate for SSI) and resources (must be $8,000 or less). There are other, more complicated considerations— such as estate recovery—that could be taken into account.
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.