What is a Medicaid Waiver Program?
Waiver Programs help provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community. Prior to 1991, the Federal Medicaid program paid for services only if a person lived in an institution. The approval of Federal Medicaid Waiver programs allowed states to provide services to consumers in their homes and in their communities.
Home and Community-Based Services (HCBS) Waiver Programs are available in Pennsylvania to provide supportive services to qualified individuals who wish to remain in their home and/or community rather than enter an institution (such as a nursing home or intermediate care facility).
There are currently 10 programs available to adults in Pennsylvania. Some of these Waiver programs are currently closed to new applicants. The HCBS Waiver programs differ in terms of the population they serve, the number of people they can serve, the application process, the criteria that must be met in order to qualify, and the services provided.
What are HCBS Waiver Programs?
These are programs that provide long-term care services and supports to individuals at risk for institutionalization but who want to remain living in their home and/or community. Waiver programs provide certain medical and non-medical services to individuals in their home or in another community-based setting in order to help them remain living independently in the community (which is the preference of most individuals). The services provided under the various programs are not typically covered under Medicare and/or Medical Assistance, especially on a long-term basis. Examples of Waiver services include: skilled nursing coverage, personal care assistance services, and home modifications. The services available differ depending on the Waiver program the person qualifies for and the service plan that is developed to address the individual’s needs.