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Waivers

Medical Assistance Waivers

1915(c) Home & Community-Based Waivers (“HCBS Waiver Program”)

1915(c) waivers are one of many options available to states to allow the provision of long term care services in home and community based settings under the Medicaid Program. States can offer a variety of services under an HCBS Waiver program. Programs can provide a combination of standard medical services and non-medical services. Standard services include, but are not limited to: case management (e.g., support and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.

Pennsylvania Waivers for those Individuals With Intellectual Disabilities

For Individuals with a primary Intellectual Disability diagnosis in Pennsylvania, there are two available medical waivers: the consolidated waiver and the person/family support waiver. First, however, it is necessary to define “intellectual disability.”

Intellectual disability is a below-average cognitive ability with three characteristics:

  • An IQ between 70-75 or below;
  • Significant limitations in adaptive behaviors (the ability to adapt and carry on everyday life activities such as self-care, socializing, communicating, etc.); and
  • The onset of the disability occurs before age 18.

Intelligence refers to general mental capability and involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly, and learn from experience. Studies show that somewhere between one (1) and three (3) percent of Americans have intellectual disabilities. There are many causes of intellectual disabilities, including physical, genetic and/or social factors.

The most common syndromes associated with intellectual disabilities are Autism, Down syndrome, Fragile X syndrome and Fetal Alcohol Spectrum Disorder (FASD). Common causes occur from genetic conditions (Down syndrome and Fragile X syndrome are examples), problems during pregnancy (a pregnancy of the mother who drinks alcohol while pregnant can result in FASD), problems at the time of birth, health problems such as whooping cough, measles or meningitis, and exposure to environmental toxins like lead or mercury.

The impact of having an intellectual disability varies considerably, just as the range of abilities varies considerably among all people. Individuals may take longer to learn and provide for their Activities of Daily Living (ADL’s).

Both the consolidated and person/family directed support waivers are available to those individuals with intellectual disabilities:

Consolidated Waiver for Individuals with Intellectual Disability

The Pennsylvania Consolidated Waiver for individuals with intellectual disability is designed to help persons with intellectual disabilities live more independently in their homes and communities and to provide a variety of services that promote community living, including self-directed service models and traditional, agency-based service models, and be the age of three or older.

Person/Family Directed Support Waiver

The Pennsylvania Person/Family Directed Support Waiver is designed to help persons with developmental disabilities live more independently in their homes and communities and to provide a variety of services that promote community living, including self-directed service models and traditional, agency-based service models, and be age three or older.

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