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Navigating the waiver system: part 2

If you’re new to the waiver system, it can be overwhelming. This guide will help you understand all the different words, phrases, and acronyms you might come across. Most of the time you will see and hear these phrases and acronyms when starting the waiver system process. Some of these terms and acronyms may already be familiar or you may be hearing them for the first time. By the end of this article you will have a better understanding of what each of these terms mean and in no time you will be a pro!


AAW- Adult Autism Waiver


The AAW provides long-term services to individuals aged 21 years or older with autism spectrum disorder. The program allows individuals to participate and thrive within their community. Some of the eligibility requirements include: being 21 years or older, diagnosis of autism, medical evaluation, financials, and MA eligibility.


Community Living Waiver


The Community Living Waiver supports individuals with IDD and autism to help them function more independently in their homes and communities. The difference between a consolidated waiver and a community living waiver is that those who receive a community living waiver, live independently or with family. You can read more about this waiver eligibility criteria Community Living Waiver.


Consolidated Waiver


The consolidated waiver assists individuals with an intellectual disability, autism, or developmental disability to live more independently in their homes and communities. This waiver is for a person of any age who has a diagnosis of Intellectual Disability or autism that was diagnosed prior to the age of 22. The eligibility criteria for this waiver includes significant adaptive skill deficits in three or more of these life activities: understanding use of language, learning, mobility, self direction and living independently. This waiver can also be used for a child who is age 8 or younger who has been diagnosed with a developmental disability with a significant chance of being eventually diagnosed with intellectual disability or autism. This specific waiver is reserved for those with extensive needs. Those who receive the Consolidated Waiver usually live in a residential home. You can read more about the Consolidated Waiver here at PA Department of Human Services.




CPS- Community Participation Supports


CPS gives individuals the opportunity to participate in and spend time in community settings. These supports promote relationship building, new opportunities, and contributing to the community. Community Participation Supports embrace client choices and preferences.


HCBS Waivers- Home and Community Based Services Waivers


Think of the HCBS waivers as the umbrella of all of the waiver programs. HCBS waivers enable those with intellectual disabilities and autism to remain in their own communities instead of moving into a long term care facility. Currently, the HCBS has 12 programs in its system. You will hear and see this term when starting the waiver application process. You may also hear or see HCBS waivers occasionally if you are speaking with someone like a support coordinator when working to obtain or maintain waiver services. Since individuals are usually diagnosed as a child, school districts will make referrals to assist with the beginning process of waiver services and support coordination. If you or a family member has just moved to Pennsylvania you can visit: Eligibility Intellectual Disabilities to find out how to obtain a waiver. You can also contact Three Rivers Community Care with your questions too.


Eligibility


Eligibility refers to the right to obtain services. This means that an individual has met all qualifications in order to receive waiver services as determined by the Department of Human Services.


HAB-Habilitation


Habilitation are services that will help individuals improve or learn new skills. They can include: budgeting money, doing laundry, or making a bed. Habilitation services can also include speech or occupational therapy.


ICF- Intermediate Care Facility


An Intermediate care facility provides care to individuals who are unable to care for themselves due to intellectual disabilities. Medical Assistance provides the funds required for care facilities. These facilities differ from rehabilitation facilities or nursing homes because they do not typically focus on medical services. Services that are offered at intermediate care facilities include opportunities for personal growth development such as learning to get dressed or undressed, bathing and showering, basic hygiene skills, housekeeping, and transportation to and from activities and appointments.


IDD-Intellectual and Developmental Disability



Intellectual and developmental disability is used to describe an individual who has certain limitations in mental functioning and skills such as communicating and personal care. Intellectual and developmental disabilities are typically identified during childhood and adolescence. Causes of Intellectual disabilities include: injury, disease, or complications during pregnancy or childbirth.


ISP- Individual Support Plan


The ISP is a document that details what is most important to the individual with intellectual disabilities. This is established to ensure that everyone who is supporting the individual can focus on what is most important to the individual. Sections within the ISP contain personal information, medical history, concerns, communication preferences, dreams, and wishes. Those involved in the development of the ISP include the support coordinator, the individual, and the individual's family. This may sound similar to an IEP, also known as an Individualized Education Plan. An IEP maps out special education, instruction, and all related supports that a student may need to thrive in school. However, an ISP is designed for the individual to achieve personal goals.


MA- Medical Assistance


Medical Assistance (MA), commonly known as medicaid pays for health care services for eligible individuals. It is common for adults with intellectual disabilities and autism to already have MA, since they may have had it since they were a child. This is a common term and you are most likely to hear or see it when working with the Department of Human Services.



OBRA Waiver- Omnibus Budget Reconciliation Act Waiver


The OBRA Waiver is a program that will assist an individual with a developmental or physical disability. It is designed to enable individuals to live within their community and remain independent.


ORC- Other Related Conditions


ORC describes an individual who may have serious physical disabilities such as spina bifida or cerebral palsy diagnosed before age 22 and are likely to continue indefinitely. In order for this to be considered Other Related Conditions all conditions must be diagnosed prior to the age of 22.


Person and Family Directed Services Waiver (Sometimes referred to as PFD Waiver by Support Coordinators-


This waiver is for individuals of any age who have been diagnosed with IDD or autism. Those eligible also include children under the age of 9 with a high probability of being diagnosed with either autism or intellectual disability and children under the age of 22 who are developmentally disabled due to a severe medical condition. This waiver also provides services such as behavioral support, companionship, assistive technology for those who have communication difficulties, consultation nutritional services, music and art therapy. This waiver is very common for individuals to start out with when first entering the waiver system This waiver is helpful to those who need habilitation and community based support. Any participant of this waiver cannot reside in a personal care home with more than 8 residents (if he or she moved there after 7/1/2008). You can read more about eligibility and services provided by the PFD Waiver here.


SC - Support Coordinator


A SC will discuss with you opportunities for support and services. They will discuss with you which supports and services are important to you and will assist you in the completion of applications for services. Support coordinators will also help create an individualized plan also known as an Individual Support Plan (ISP), defined later in this article.


SCO-Support Coordinator Organizations


A Support Coordinator Organization (SCO) are providers that will help locate services to assist individuals with obtaining, coordinating and monitoring services in waiver programs.


SSI- Supplemental Security Income


SSI pays monthly benefits to people who have limited income and resources, are disabled, blind or over the age of 65. Individuals who are eligible and collect SSI are also eligible to receive Medical Assistance (MA).


Here at Three Rivers Community Care we know that processing and understanding all of the intricacies of the waiver system can be a challenge. We are always here to help you navigate through the learning process. Please reach out to us directly should you ever have any questions! We do free consultations to help families understand the waiver system.


Reference(s):


Home and Community-Based Services

Adult Autism Waiver (AAW)

Medical Assistance

Eligibility Intellectual Disabilities

Services/Supports Coordinator Organizations

Understanding Supplemental Security Income (SSI) Overview -- 2022 Edition

Facts About Intellectual Disability | CDC