Families have a large financial burden when needing to care for a loved one with disabilities, along with supporting and advocating for them daily. Some families also need assistive technology for their loved one, which is very expensive. Overall, extra time and resources is required to care for their family member. These factors tend to make life overwhelming at times. This page is designed to introduce you to Medicaid Waivers. The information below may help your loved one receive the assistance they need to live a more fulfilling life. We hope this helps you understand more about waivers, as this can be confusing and take a lot of time. Medicaid Waivers are available throughout all ages of someone’s life. Check out our pages on waivers for Early Childhood and School Age as they pertain to you.
What are Medicaid Waivers?
Medicaid Waivers allow the federal government to waive rules that usually apply to the Medicaid program. Thanks to these waivers, states can provide services to their residents that may not be covered by Medicaid. For example, an individual with a disability may need a ramp installed in their home for accessibility. Insurance may not cover the payment for this, and ramps may also not be covered by Medicaid. This person can apply for a waiver to get the ramp paid for by Medicaid. Check out this site from Paying for Senior Care for more information about waivers for home modifications and assistive technology. For everything that Medicaid Waivers can cover, check out this page regarding HIE care from the HIE Help Center.
It is important to keep in mind the services and needs that you would need when choosing the correct waiver. For instance, some waivers may only cover home modifications, but not any personal care services such as cleaning or bathing. If you also needed personal care services, you would not qualify for this specific waiver.
The ideology of Medicaid Waivers is quite straightforward, and you can read the article “What is a Medicaid Waiver? Your Guide to Medicaid Home and Community Based Services” from Assisted Living Today for a more thorough understanding of what it is. There are a few different types of waivers, but for the purposes of providing funding for long-term care, you only need to consider Section 1915(c) waivers — Home and Community-Based Services (HCBS). Within HCBS waivers, there are many different forms depending on the nature of care required, type of disability, and age (the forms change for those under 60 and those 60 and over). Continue reading for a list of waivers and forms to choose the one most relevant to you.
How do I Apply for Waivers as an Adult?
After gaining an understanding how waivers can be of use to you, you need to familiarize yourself with the agencies that that can help you apply for those waivers and the agencies that process these waivers. You will notice that the articles above include some steps you need to take in order to apply for waivers. To reiterate, you must first apply for Medicaid and then request an intake for a HCBS waiver. To apply for Medicaid in Pennsylvania, visit the COMPASS site. If you need assistance, visit this page for COMPASS’ contact information.
Check out the PA Office of Development Programs (ODP) site for information regarding waivers and to gain a better understanding of their mission. There are also reports on this page, some of which can be dry and difficult to read through, but others can be very insightful, especially “Everyday Lives: Values in Action.”
The ODP is part of a larger department in Pennsylvania called the Department for Human Services (DHS). Visit the two pages Support Services Waivers and Waiver Information on their website to gain insights to the types of waivers offered in PA, their eligibility requirements, and what the forms consist of.
ODP Waivers:
Apply through your county MH.IDD office, which we have linked in our County MH.IDD page.
OLTL Waivers:
Apply through the Independent Enrollment Broker (IEB) by visiting the PA IEB website.
Toll free helpline: 1-877-550-4227
Toll free TTY line: 1-844-824-3655
How do I Apply for Waivers as an Aging Adult?
An aging adult is classified as being 60 years old or older based on PA Medicaid Waivers. Before visiting the government sites relevant to your needs, we encourage you to visit this page from Paying for Senior Care regarding the PA Department of Aging (DoA) Medicaid waivers. This page provides a good overview of the services available, as the following government sites can be difficult to navigate. The whole site is not directed towards adults with disabilities; however, it may still be useful to browse the site for additional resources relevant to your concerns. We want to point your attention to this Medicaid planning page, for example, as it may be helpful.
Check out the PA Long Term Care Services site for information on aging waivers. Note, however, that if a person is diagnosed with an intellectual disability, then the ODP is applicable to all ages, but if a person is diagnosed with a physical disability, then the OLTL is more applicable for adults. If you need assistance or have questions, you can call the toll-free Long-term Care Helpline provided by OLTL at 1-800-753-8827.
The PA Department of Aging is a good information-referral resource for aging adults with disabilities. We encourage you to visit their Local Resources page, where you can find relevant information regarding Area Agencies of Aging (AAA), Adult Day Centers (ADC), and Senior Community Centers. This page will link you to the corresponding organization in your area.
