Waivers

"Waivers" are programs that are designed to help an eligible individual stay in his or her home and community-based setting, rather than moving to an institution because of a need for care. They are developed by the states with federal financing.

The states "ask" the federal government to waive (not apply) certain limits that otherwise apply to the Medicaid insurance program. This enables the states to go beyond the Medicaid rules and offer supports and services to specific segments of the population. These segments of the population sometimes reside in a particular geographic location of their state; sometimes they have a particular diagnosis or a particular need.

A waiver allows for extra care that is beyond what is typically provided through Medicaid insurance. With the extra care, the individual is able to remain in his or her home or in a community program rather than having to move to an institution to receive the support the individual needs. (Examples of institutions are hospitals, skilled nursing facilities, or Intermediate Care Facilities.)

In Pennsylvania, there are four waiver programs which apply to individuals with developmental and/or intellectual disability. There is also one other waiver program that may be applicable to individuals on the autism spectrum, depending on the individual's primary diagnosis. These waivers are briefly described below. Links to additional information are provided at the end of the article. Additional articles in the Government & Legal section of the CAR Autism Roadmap™ provide more detailed information on specific waivers and public benefits programs.

• Adult Autism Waiver — for adults, 21 years and older, with a diagnosis of Autism Spectrum Disorder (ASD); administered by the Bureau of Autism Services
• Person Family Directed Waiver — for individuals with developmental disabilities, as young as 3 years old; administered by the Office of Developmental Programs
• Consolidated Waiver for Individuals with Intellectual Disability — for individuals with intellectual disabilities, as young as 3 years old; administered by the Office of Developmental Programs
• Independence Waiver — for adults, 18 — 60 years, with a severe physical disability, who do not have intellectual disability or a mental health disorder as a primary diagnosis, and who are clinically eligible for a nursing facility; administered by the Community Services Programs for People with Disabilities; rarely applicable to autistic individuals
• OBRA Waiver — for adults, 18 — 59 years, who have severe developmental physical disabilities that were diagnosed before age 22, which cause limitations in at least three of the following: mobility, communication, self care, self direction, and capacity for independent living and learning; administered by the Community Services Programs for People with Disabilities; currently not accepting new applications

Additional Resources:

• List of Waivers in All States From medicaid.com
• Pennsylvania Health Law Project's Guide to Home and Community Based Services (HCBS) Waiver Programs: a Manual for Consumers and Advocates in Southwestern PA
• Adult Autism Waiver
• Pennsylvania Person/Family Directed Support Waiver
• Pennsylvania Consolidated Waiver
• Independence Waiver
• OBRA Waiver