Guide to Medicaid Waivers for Intellectually Disabled Pennsylvanians
An intellectual disability affects an individual’s capacity to function in daily life and to learn at the expected level. It can be caused by an issue that occurs before a person reaches adulthood—or even before they are born. Individuals may show signs of intellectual disabilities as a result of any number of injuries, diseases, or neural problems. However, the most well-known causes include Down syndrome, fetal alcohol syndrome, certain genetic conditions, birth defects, or infections.
Here in Pennsylvania, about 2,667,350 people are currently living with an intellectual disability. Of that number, 11% require assistance with mobility and cognition, 7% with independent living, 6% with hearing, 4% with vision, and 3% with self-care habits.
Supports Coordination connects residents with intellectual disabilities to valuable resources, but for those who need additional attention, a limited amount of Medicaid waivers are currently available through the Pennsylvania Office of Developmental Programs (ODP).
What is a Medicaid waiver?
A Medicaid waiver provides funding for essential services in support of people with intellectual disabilities. The purpose of the waiver is to allow the individual to live a more comfortable life in their community or home.
A selection of highly qualified providers, due process, and health/safety insurance is available to those who are part of the program.
Who is eligible for Medicaid/medical assistance programs?
There are multiple assistance programs available in Pennsylvania, and each has its own set of requirements to meet eligibility. A few beneficial Medicaid waivers for intellectual disabilities are the PFDS, consolidated, and community living programs.
Medicaid waivers offered through PA ODP
PFDS Waiver
The PFDS waiver is intended for those with an intellectual disability, autism, or developmental disability. Its main purpose is to assist them with living a more independent lifestyle.
Individuals who meet the standard criteria include:
- Any person (of any age) living with either autism or an intellectual disability
- Children under the age of 9 with a high probability of developing autism or an intellectual disability
- Children under the age of 22 living with a developmental disability from a medical condition
This Medicaid waiver is recommended for people of an intermediate level of facility care. They must also meet the financial requirements set by the County Assistance Office. The cost limit is set at $41,000 per person per year.
Consolidated Waiver
The consolidated waiver is very similar to the PFDS waiver in that it was created to assist those living with an intellectual or developmental disability. It aims to connect these individuals with their communities and provide them with services for independent living.
Requirements for this Medicaid waiver include the conditions listed above as well as a diagnosis of an intellectual or developmental disability. Again, the consolidated waiver is intended for people who depend upon an intermediate level of care and who meet the necessary financial requirements. A few of its covered services include (but are not limited to) assistive technology, counseling, communication specialists, education support, caregiver training/support, therapy, and transportation.
Community Living Waiver
The community living waiver supports individuals with an intellectual disability by providing them with services related to self-direction, choice/control, communication, employment, and a community-based lifestyle. Basic requirements for this Medicaid waiver are essentially the same as the previous sections, including a thorough medical evaluation and diagnosis of disability. Applicants must meet all financial demands established by the local County Assistance Office. The cost limit is $85,000 per person per year, excluding Supports Coordination.
Covered services include (but once again are not limited to) supported employment, community participation support, family medical support, life sharing, vehicle accessibility, and respite.
Find a more fulfilling life through ECCM
ECCM helps individuals with intellectual disabilities live fuller, happier, more supported lives. Contact us today to find out more about what we offer, and how we can help you with your personal needs.