From Autism Transition Handbook
Support Services Overview
What are Waivers?
“Waivers” is a shortened term to describe the Medicaid Home and Community Based Waiver Program. This program provides funding for supports and services that help individuals with disabilities live in their homes and communities. Services offered go beyond those provided by Medical Assistance in order to help the individual remain in the community, rather than being admitted to a Long-Term Care Facility. Unlike Medicaid, waivers are not an entitlement program and may have long waiting lists. Most states offer waivers to provide home- and community-based services to people with developmental disabilities (DD), which may cover individuals with autism. For a complete list in your state, you can go directly to the agency within your state that administers the waiver program. Alternatively, you can find a complete listing of waiver programs at the Centers for Medicaid and Medicare services website.
In recent years, many states have added a waiver program specifically for individuals with autism. Currently, there are 11 states with autism waivers, largely for children: Colorado (0-6), Indiana (0 to no max), Kansas (0-5), Maryland (1-21), Massachusetts (birth to 8), Montana (1-4), Nebraska (0-17), North Dakota (birth to 4), Pennsylvania (21 and older), and South Carolina (3-10). These waivers have different requirements, and cover different services such as intensive individual supports, respite, case management, adaptive equipment/environmental mods, OT, PT, speech/language therapy, transportation, individual goods and services, program design & monitoring, adult day, day services, rent and food for unrelated live-in caregiver, residential hab and support, adult foster care, behavioral support services/crisis assistance, community transition, family and caregiver training, music therapy, psychological therapy, recreational therapy, and specialized medical equipment and supplies.
How Do I Know Which Waiver(s) My Child May Be Eligible For and Which One is Best for My Child?
Choosing the right waiver depends upon what your child's specific needs are. Prior to starting the process, it is a good idea to read the eligibility factors for each waiver, and see which one best fits your child's situation and needs. It may be possible that he or she is eligible for more than one waiver; in this case, you may want to apply for more than one waiver. Also, if your child is already covered under one waiver, but you want to apply for a different waiver, you may also do this. Please note, in this case priority for waivers are given to individuals who do not already have a waiver.
Waiver Funded Services to Support Living in the Community
Home and Community Services waivers can help your son or daughter gain, maintain, and improve skills that allow them to live and participate in their local community. The following is a description of waiver services that may be available:
- Habilitation is designed to assist individuals to gain, maintain, and improve skills in the areas of self-care, daily living activities, social skills, and to enable the person’s involvement in community activities. These services help people live in their home; participate in local community activities; use community resources such as parks, pools, movies etc.; and access informal supports such as service clubs, senior programs, and other community opportunities. Services can be provided by a service agency that provides trained individuals to provide assistance or by someone the person and family already knows who is qualified and willing to provide assistance.
- Community Habilitation is delivered in an Adult training facility licensed by the Department of Public Welfare under the Ch. 2380 regulations. Adult training facilities provide services that assist individuals in meeting personal needs and performing basic daily activities. JCAHO Accredited/MA Certified Non-Residential Agencies providing Community Habilitation assist individuals in acquiring, retaining, and improving self-help, socialization, and adaptive skills.
- Transportation services are offered to enable individuals to gain access to their community including both services and informal supports. Transportation covers emergency transportation in certain circumstances.
- Older Adult Day Services support people in meeting their personal care and social needs. They are provided in a center that is regulated under the Department of Aging Ch. 11 Older Adult Living Centers.
- Home Finding services provide assistance with activities related to self-determined housing. These include education about housing, and home ownership working with landlords, location of housing, and assessment for appropriate physical adaptations to make housing accessible.
- Environmental Accessibility Adaptations: Vehicle Adaptations for improved access and/or safety. Home Adaptations to homes for improved access and/or safety.
- Adaptive Appliances/Equipment The purchase or modification of items for increased functional involvement by individuals in activities of daily living.
- Habilitation Supplies for direct use by individuals and/or caregivers to address health and safety needs. Supplies are limited to those listed in the long definitions document.
- Homemaker Indirect services including household cleaning/maintenance and homemaker activities such as meal preparation. The initial duration of this service is limited to one month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service. After six (6) weeks, additional criteria must be met to extend the service. There is no funding cap for this service in the P/FDSW. The consolidated Waiver funding for homemaker and chore services combined may not exceed a total of $2000 in a fiscal year.
- Chore indirect services including household cleaning/maintenance and homemaker activities such as meal preparation. The initial duration of this service is limited to one month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service. After six (6) weeks, additional criteria must be met to extend the service. Consolidated Waiver funding for homemaker and chore services combined may not exceed a total of $2000 in a fiscal year. There is no funding cap for this service in the P/FDSW.
- Residential Home and Community Habilitation - Licensed Homes Direct service and services to meet regulatory requirements and contract conditions provided in licensed community homes to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills
Support Services for Individuals with Autism in Pennsylvania
What Waivers are Available in PA and Who is Eligible?
Eligibility for these waivers is generally based on the income of your son or daughter, not that of the parent. The Pennsylvania Department of Public Welfare administers 12 waiver programs of which four apply to individuals with Developmental and/or Intellectual Disabilities including Autism, and another two which may be applicable depending on the primary diagnosis of your son or daughter. The specific waivers include:
• Person/Family Directed
• Adult Autism
Each waiver has its own set of eligibility requirements, they are limited in availability (they are not an entitlement program like Medicaid) and may have long waiting lists. Additional requirements for Commcare, OBRA and Independence Waivers can be found here. The Bureau of Autism Services oversees the Adult Autism Waiver and ACAP programs; ODP through the county MH/MR offices oversee the Consolidated and Person/Family Directed Waivers. For waiver service definitions click here See Also:
Pennyslvania Health Law Project's excellent summary on waivers, Home and Community Based Services Waiver Programs
How do I Apply for a Waiver in Pennsylvania?
Waivers are administered through various departments within the Department of Public Welfare. The particular process you go through depends on which department oversees the waiver that you are applying for. See below for a list of waivers and their corresponding department:
The Bureau of Autism Services:
- Adult Autism Waiver
- Adult Community Autism Waiver
To receive an Application you must call them at: 1-866-539-7689. They will answer questions via email at RAemail@example.com, but they will not accept email requests for applications. For more information on applying for these programs, click here
The Office of Developmental Programs:
- Person/Family Directed
Registration: These waivers require that you register for I/DD services in your county. To register for I/DD Services in your county, contact the county intake officer at your local MR/MH office. The first step is to provide a record of Intellectual/Developmental Disability diagnosis to the Intake Officer. The documentation must include:
• completed IQ test by a licensed clinician or certified school psychologist with an IQ score of 70 or lower (clinical judgment may apply),
• completed Adaptive Behavior Scale (ABS) showing deficits in two or more areas of adaptive functioning, and
• a record of MR diagnosis, signed by a licensed clinician or certified school psychologist, prior to age 22.
After the intake officer reviews the documents, the family is provided with a written notice of eligibility. If the family is eligible, the family will be contacted for a meeting and assigned a Supports Coordinator to begin service planning. If your child is found not to be eligible, a written report of the decision will be sent to the family, and you will be given information about the appeals process. You can also register online through Compass. Compass is Pennsylvania’s fast and easy way to apply online for Health and Social Services. Screening helps you find services for which your family qualifies. For additional information on the county mental health system, click here.
Accessing I/DD Waivers
Once the registration process is complete, it is then necessary to apply for an I/DD waiver. To apply for an I/DD waiver (Person/Family Directed, Consolidated and OBRA) you will need to fill out the appropriate Waiver Application Form. You may also register online through PA's COMPASS system for the Consolidated Waiver and the Person/Family Directed Waiver. You will need Documentation to complete the registration process.
Many families chose to apply directly to the local MR/MH office for waiver supports. Once an application has been made, MH/MR meets with the participant and/or a family member to complete a Priority of Urgency of Need for Services for Persons with Mental Retardation (PUNS) form which results in a ranking for need for supports: emergency (immediate), critical (within one year) and planning (more than a year away). Final determination is made by the County MR office regarding eligibility for waiver services and letter is mailed to you. You will need to coordinate these services with your Supports Coordinator, and complete an Individual Supports Plan. When you are within 6 months from graduating, your status can move from critical to emergency for receiving services. This will allow more time for county to coordinate resources. Please note that the OBRA waiver is closed.
The Community Services Programs for Persons with Physical Disabilities:
- OBRA Waiver (closed)
- Independence Waiver
- COMMCARE Waiver (closed, may re-open in the Spring of 2011)
To apply, contact the enrollment agency in your county where an intake coordinator will guide you through the application process. This information can be found by clicking here
The HCSIS Services and Supports Directory is a tool for individuals with intellectual and developmental disabilities, their families, and circle of support to locate services and service providers in the Commonwealth of PA. It can be found at https://www.hcsis.state.pa.us/hcsis-ssd/pgm/asp/prhom.asp
Once I Am Approved for a Waiver, Do I Automatically Receive Supports?
Waiver funding is dependent on the available funds each county has for a particular waiver. So it is possible to be eligible for funding, but not actually receive funding. In this case, the individual will be put on a waiting list. The Office of Developmental Programs provides a specific amount of waiver funding to each county. Counties must consider a number of factors including the priority of other individuals on the waiting list, and individuals already receiving waiver funding. Generally, individuals in the “emergency” category receive priority for funding, but may also have to wait. During this waiting period, supports often must be focused on family members and friends, and other natural supports in your community such as YMCA's, local recreation centers, and local volunteer groups. At this time, it is also helpful to contact advocacy groups to help obtain supports.
A Comparison of Services for Adults with Autism in Pennsylvania
The Adult Community Autism Program
The Adult Community Autism Program (ACAP) is a Managed Care program that provides an innovative approach to services for individuals with autism, and is administered by the Bureau of Autism Services . It provides physician, behavioral, and community services through an integrated approach to create a coordinated system of supports. In this way it is a managed care program, rather than a traditional waiver program. Other unique aspects include:
- Currently available in 4 counties (Lebanon, Cumberland, Dauphin, Chester)
- ACAP becomes the participant’s health plan
- Most services are provided by Keystone Autism Services and their network of providers (e.g., primary care physicians)
- Participants cannot require 16 or more hours of awake support, at intake
- Live in one of the counties being served by ACAP
- Have a diagnosis of Autism Spectrum Disorder
- Meet MA qualifications
- Met federal level of care
- Be 21 or older
More information can be found by clicking here
How are the Adult Autism Waiver and Adult Community Autism Program Different from other Waivers?
Specifically designed to meet the needs of people with Autism Spectrum Disorder
- Administered at the state level directly by BAS
- Does not use IQ as an eligibility factor
- Providers required to complete autism-specific training & demonstrate competence
- Clinical and technical assistance available to enrolled providers
- Service planning and measures of success based on individual goals
- Services based on proven approaches to help individuals realize their goals
What are the Differences between the Adult Autism Waiver and the Adult Community Autism Program?
|Adult Autism Waiver||Adult Community Autism Program|
Currently available in only 4 counties
Physician services are not provided: Participant
retains Health Choices
ACAP becomes participant's health plan and integrates
pyscial, behavioral and community services
|Enrolled provider is chosen for services||
Most Services are provided by Keystone Autism Services
and their network of providers
Designed to provide long term care if needed;
participant can require 24/7 services
At intake participant can require no more than 16 hours
of awake support
How are the Adult Autism Waiver and ACAP Similar to Each Other? The features that make the Adult Autism Waiver and ACAP different from other adult programs in Pennsylvania are the characteristics they share. Eligibility requirements are also consistent between the two programs. To be eligible for either program, the individual served must:
- Be a PA resident
- Have a diagnosis of Autism Spectrum Disorder (ASD)
- Meet MA qualifications
- Meet federal Level of Care
- Be 21 or older
DPW's where do I begin?
Support Services for Individuals with Autism in Delaware
What Waivers are Available in Delaware and Who is Eligible?
In Delaware there are five available waivers. You may only be in ONE waiver at a time. The waivers are for Acquired brain injury, AIDS/HIV (AHW), Assisted living, Developmental Disabilities (DD), and Elderly and Disabled (E&D). The waiver that an adult with autism would apply for is the Developmental Disabilities waiver.
Why is it essential to apply for a waiver immediately after graduation?
In Delaware, there is funding for adults completing high school and moving on to the community. This funding is from the Joint Finance Committee and is available through DDDS. There are approximately 150 graduating seniors each year in Delaware and all of them are eligible for the waiver.
In the case that a family applies later on for waiver services, there may be a wait of several months to two years for services. The program is sponsored 50 % federally and 50% by the state of Delaware. If the person qualifies for “emergency status” they can receive services more quickly.
What is covered under the Delaware waiver?
The Delaware waiver covers housing, day programs, employment services, case management, and respite. The amount of respite varies case by case and depends on the needs of the family and the level of care of the child.
How do I know if I qualify for a Delaware waiver?
In order to qualify, you must
- Be a Delaware Resident
- Make a referral to the appropriate office
- Complete a Medicaid application
- Be determined financially eligible
- Qualify for a medical level of care
- Be able to be safely maintained in the community
The level of care is determined by showing deficits in at least two areas of functioning. This can be through testing completed by the school that is then forwarded to DDDS or by DDDS completing the testing.
Qualifying disorders include Aspergers, PDD NOS, Autism, Prader-Willi Syndrome, Brain Injury, etc.
How do I apply for the Developmental Disabilities waiver?
The Developmental Disabilites waiver in Delaware is administered by the Division of Developmental Disabilities (DDDS). Before you can apply for the waiver, the first step is to apply to DDDS. This can be done by calling 1-866-552-5758. They can mail, email, or fax you an application. If you qualify for these services, you will be connected with a Family Support Specialist (Case Manager) and be eligible for Respite services. The DDDS services are NOT based on income. You may qualify for DDDS services, but not be eligible for a waiver. DDDS services are available starting at 3 years of age.