Navigating the system: Medicaid waivers for people with intellectual disabilities or autism
By Courtney Brown
Maneuvering through the processes of finding services and determining eligibility for programs for people with intellectual disabilities or autism can appear daunting. This article aims to provide relevant information for those new to the waiver system, those wanting to learn more, and/or
those who are seeking clarification. This article goes over what waivers are, types of waivers, eligibility, and how to obtain services through a waiver program.
What is a Medicaid Waiver?
This is a program offered through Pennsylvania Medicaid that assists in providing services for individuals with autism or intellectual disabilities (IDD). These programs provide both home and community-based services and are commonly known as “HCBS Waivers”. They allow an individual to live independently.
Medicaid waivers are federally funded programs within the United States. The federal government “waives” Medical Assistance rules, which enable the state to use the funding to provide support for individuals with autism or intellectual disabilities. Supports can include
community support, in-home support, transportation, and assistance with employment opportunities. Services such as these are generally not covered under Medical Assistance. Waivers vary from state to state, and sometimes the types of waivers will vary from county to county. Each state uses their own methods for how they utilize funds for the waiver programs.
Types of Pennsylvania Waivers
There are five HCBS Waivers in Pennsylvania that can assist in providing support for individuals.
▪ Community Living Waiver
▪ Consolidated Waiver
▪ PFDS Waiver
▪ Adult Autism Waiver
▪ Omnibus Budget Reconciliation Act (OBRA) Waiver
Eligibility and Requirements
As with most programs in Pennsylvania, individuals seeking waivers must meet certain financial eligibility criteria. Income criteria is calculated based on the individual's income and assets. The individual’s income cannot exceed 300 percent of the Supplemental Security Income (SSI) standard which is $2,250 per month. However, it's important to know that this amount can change yearly. SSI is a federal program that provides monthly payments to adults and children
with a disability or blindness who have income and resources below specific financial limits. An individual’s countable resources (i.e. personal property or assets) cannot exceed $8,000 a month. Eligibility is based solely on the individual. It includes all of their assets. So this individual receiving a waiver would most likely not own a home, car, or anything that would put them over the limit.
How To Obtain Services
Since each waiver has its own rules and eligibility requirements. The state will need to see that an individual needs support to live and work in the community. Through an assessment, the state determines how much support the individual needs in home and community settings which ultimately decides waiver eligibility. After that process is complete, the individual and/or the individual’s family can choose a service provider such as Three Rivers Community Care to help meet their needs.
References:
Medicaid Waivers for Individuals with Autism — PAAutism.org, an ASERT Autism Resource Guide
MEDICAID WAIVERS FOR PEOPLE WITH INTELLECTUAL DISABILITIES OR AUTISM
Understanding Supplemental Security Income (SSI) Overview -- 2022 Edition