Home and Community Based Services

General Information

Long Term Care (LTC) services include both Home and Community Based Services (HCBS) and LTC Facility Services. A person who has a medical need for LTC services may choose which program to participate in. If a person applies for medical assistance and payment of LTC services, they must also meet the non-financial and financial medical assistance eligibility requirements.

Long Term Care Facility Services

Long term care facilities, also known as nursing homes, provide both short and long term nursing and rehabilitation services for persons that require 24 hour care. A list of LTC facilities in Pennsylvania may be found via the PA Department of Health web site.

A person may also compare long term care facilities at Medicare.gov.

Home and Community Based Services

Home and Community Based Services are also known as Waiver Funded Services or Waiver Programs. The name waiver comes from the fact that the federal government "waives" medical assistance rules for institutional care in order for Pennsylvania to use the funds for HCBS. HCBS provides for supports and services beyond those covered by the Medical Assistance (also referred to as Medicaid) program that enable a person to remain in a community setting rather than being admitted to a Long Term Care Facility. Currently the Department of Human Services administers 12 HCBS programs. Each HCBS program has its own eligibility requirements and services.

If a person is determined eligible for more than one HCBS program, the person cannot receive services under two or more such programs at the same time. The person must choose one HCBS program and receive the services provided by it.

A List of the available Home and Community Based Programs and their associated eligibility requirements follows:

WaiverFunctional Eligibility RequirementsServices Provided

Community Living Waiver

 

*No age limit for intellectual disability or autism.
*Developmental disability with a high probability of resulting in an intellectual disability or autism are eligible from age 0 through 8
*Require an ICF/ID or ICF/ORC level of care
*Individual cost limit of $70,000 per person per fiscal year (Supports Coordination is excluded from this limit)

*Employment Services (job finding and job coaching)
*In-Home and Community Support
*Companion
*Community Participation Support
*Respite
*Shift Nursing
*Therapies
*Behavioral Support
*Assistive Technology
*Home and Vehicle Accessibility Adaptations
*Transportation
*Life Sharing
*Supported Living
Aging Waiver

*Age 60 or older
*Meet nursing facility level of care criteria
*Wish to be treated in own home or other community setting
 

*Adult Day Services Center
*Attendant Care
*Counseling
*Environmental modifications
*Home health care
*Specialized medical equipment and supplies
*Companion Services
*Respite Care
*Transportation
*Home delivered meals
*Extended physician services
*Personal care services
*Personal emergency response system
 
Attendant Care Waiver *Age 18 through 59 (over age 59 conditional)
*Requires assistance with activities of daily living due to a medically determined physical impairment which can be expected to last for a continuous period of not less than 12 months
*Mentally alert and capable of selecting, supervising, and if needed, firing an attendant, and managing their own financial and legal affairs
*Be found in need of a basic service
 
*Basic Service includes:
-Assistance with getting in and out of bed, wheelchair and/or motor vehicle
-Assistance with performing activities of daily living such as bathing, personal hygiene, feeding and health maintenance activities
 
Independence Waiver*Age 18 and older
*Requires nursing facility level of care
*Persons with physical disabilities
*Disability results in at least 3 substantial functional limitations
*Disability is expected to continue indefinitely
*Not dependent on mechanical ventilator supports
 
*Daily living services
*Environmental adaptations
*Assistive technology/ specialized medical equipment and supplies
*Community integration services
*Respite services
*Transportation
 
Adult Community Autism Program (ACAP)*21 years or older
*Diagnosis of Autism Spectrum Disorder (Autistic Disorder, Childhood Disintegrative Disorder, PDD-NOS, Asperger Syndrome or Rett Disorder)
*Require Intermediate Care Facility (ICF) level of care
*Be able to live in a home or community setting without 16 hours or more per day of awake staffing and supervision
*Not have behaviors that are dangerous to yourself or others or that could cause harm to property
*Physician, ICF, psychiatric, nursing facility, hospice services
*Dental, vision, speech, podiatry, chiropractic services
*Medical supplies and equipment
*Health promotion and disease prevention services
*Targeted case management
*Mental health crisis intervention services
*Adult day habilitation services
*Homemaker services
*Residential & behavioral support
*Respite care
*Supported employment
*Community transition services
*Environmental modifications
*Assistive technology
*Family counseling
 
Adult Autism Waiver (AAW)*Age 21 or older
*Diagnosed with Autism Spectrum Disorder (Autistic Disorder, Childhood Disintegrative Disorder, PDD-NOS, Asperger Syndrome or Rett Disorder)
*Meet Intermediate Care Facility level of care
 
*Assistive technology
*Behavioral health services
*Community inclusion
*Community Transition Services
*Counseling
*Day & residential habilitation
*Environmental modifications
*Family counseling & training
*Job assessment and finding
*Nutritional consultation
*Occupational therapy
*Respite
*Speech/ language therapy
*Supported employment
*Supports coordination
*Temporary crisis services
*Transitional work services
 
Infants, Toddlers and Families Waiver*Between birth and age 3
*In need of early intervention services
*Meet Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) or Intermediate Care Facility for Persons with Other Related Conditions (ICF/ORC) level of care
 
*Habilitation, which is a service provided in home and community settings to assist a child in acquiring, maintaining and improving self-help, domestic, socialization and adaptive skills
Person/Family-Directed Support (P/FDS) Waiver*No age limit for intellectual disability or autism.
*Developmental disability with a high probability of resulting in an intellectual disability or autism are eligible from age 0 through 8
*Require an ICF/ID or ICF/ORC level of care
*Individual cost limit of $33,000 per person per fiscal year (Supports Coordination and Supports Broker are excluded from this limit.  There are also some exceptions for employment service.)

*Employment Services (job finding and job coaching)
*In-Home and Community Support
*Companion
*Community Participation Support
*Respite
*Shift Nursing
*Therapies
*Behavioral Support
*Assistive Technology
*Home and Vehicle Accessibility Adaptations
*Transportation
 

Consolidated Waiver*No age limit for intellectual disability or autism.
*Developmental disability with a high probability of resulting in an intellectual disability or autism are eligible from age 0 through 8
*Require an ICF/ID or ICF/ORC level of care
*No individual cost limit per year on services
 

*Residential Habilitation
*Employment Services (job finding and job coaching)
*In-Home and Community Support
*Companion
*Community Participation Support
*Respite
*Shift Nursing
*Therapies
*Behavioral Support
*Assistive Technology
*Home and Vehicle Accessibility Adaptations
*Transportation
*Life Sharing
*Supported Living
 

OBRA Waiver*Persons with developmental physical disabilities
*Disability results in at least 3 substantial functional limitations
*Disability manifested prior to age 22
*Age 18 or older
*Disability is expected to continue indefinitely
*Requires ICF/ORC level of care
 

*Daily living services
*Environmental adaptations
*Assistive technology
*Community integration services
*Respite services
*Transportation
*Supported employment services
*Prevocational and educational services
 

LIFE (Living Independence for the Elderly Program also known as LTCCAP)*Age 55 older 
*Meet eligibility requirements for nursing facility level of care
*Able to safely live in the community with services available through the provider
*Reside in locations where services are available
 
*Adult day health services
*Transportation/ escort services
*Primary medical specialist care
*Nursing care/skilled nursing
*Dental, vision, podiatry, audiology care
*Social services/ case management
*Physical, occupational, speech therapies
*Recreational therapy
*Nutritional counseling/ education
*Laboratory/ diagnostic test, x-rays
*Pharmaceuticals
*Prosthetics, orthotics, durable medical equipment and supplies
*Psychiatric services
*Personal care
*Homemaker chore services
*Home delivered meals
*Hospital care/ hospice services
*Nursing facility services
*Services for hearing/speech impairments
*Translation services