If you or a loved one needs support to continue living safely and independently at home, Pennsylvania’s Medicaid Waiver programs may be able to help. But figuring out where to start can at times feel like the hardest part. Applications, eligibility requirements, assessments, medical forms, and programs with different rules can feel overwhelming. For individuals and families already managing health, disability, or caregiving responsibilities, the process can quickly become overwhelming.
At A Bridge to Independence, we want you to know something important: you don’t have to go through it alone. Our experienced team helps individuals and families understand Pennsylvania’s home- and community-based services and connect with the resources and assistance that can help them move forward.
What Is a Medicaid Waiver in Pennsylvania?
Pennsylvania Medicaid Waiver programs provide eligible individuals with access to home- and community-based services (HCBS). These services help people access the care and support they need at home or in their communities rather than in an institutional setting. Depending on the program and an individual’s needs, services may include personal assistance, help with activities of daily living, home and community supports, employment services, assistive technology and other resources that promote greater independence.
A Bridge to Independence provides service or supports coordination for several Pennsylvania programs, including:
- Attendant Care Waiver
- Act 150 Program
- OBRA Waiver
- Community HealthChoices (CHC)
- Adult Autism Waiver
- Intellectual and Developmental Disability Waivers, including the Consolidated, Community Living and Person/Family-Directed Support waivers
The enrollment process differs by program. That’s one reason it can help to have someone who understands Pennsylvania’s system point you in the right direction.
Starting the Waiver Enrollment Process
For Pennsylvanians applying for certain Long-Term Services and Supports, including the Attendant Care Waiver, the PA Independent Enrollment Broker (PA IEB) serves as a primary point of contact for enrollment. The PA IEB facilitates enrollment for Pennsylvania residents seeking home- and community-based and long-term services and supports. The process normally begins by contacting the PA IEB and indicating that you would like to apply for waiver services. You can learn more or begin the process through the PA Independent Enrollment Broker.
What Happens After You Apply?
Although every situation is different, the enrollment process generally includes several important steps.
- Begin Your Application
First, let the PA Independent Enrollment Broker know you are interested in applying for waiver services. During the application process, you will be asked for information about your needs and situations and may need to provide documentation to determine whether you meet program requirements. - Complete the Required Medical Information
Your physician plays an important role in determining eligibility. According to the PA IEB, a physician must complete and submit a Physician Certification Form as part of the eligibility process. Staying in contact with your physician and making sure requested paperwork is completed can help prevent avoidable delays. - Complete an Assessment
The process also includes an evaluation of your needs and abilities. For applicable waiver programs, a functional eligibility assessment helps determine the level of care and assistance you require. This is an important part of the process because Medicaid Waiver services are designed around the individual’s needs, not simply a diagnosis. - Determine Financial Eligibility
Medicaid Waiver programs also have financial eligibility requirements. Applicants may be asked to complete a Medical Assistance application and provide financial documentation to Pennsylvania’s County Assistance Office. If supplementary information is needed, you may receive a request for documentation, so pay close attention to mail, phone calls and other communications regarding your application. - Receive an Eligibility Decision
Once the necessary medical, functional and financial information has been reviewed, you will receive a determination regarding eligibility. If you qualify, the next step is to select and coordinate the services that best meet your individual needs and goals.
What About Act 150?
Pennsylvania’s Act 150 Program is closely associated with attendant care services but is different from a Medicaid Waiver. It can provide attendant care services for certain individuals with physical disabilities who meet program requirements but may not qualify financially for Medicaid Waiver services. Because the programs and eligibility requirements can be confusing, don’t worry if you aren’t sure which program applies to you. Getting answers is part of the process.
Bridge Is Here to Help
Forms, assessments and government program terminology can make enrolling in Pennsylvania Medicaid Waiver services seem intimidating. You don’t have to understand everything before asking for help. A Bridge to Independence serves individuals throughout all 67 Pennsylvania counties, helping participants and families manage services and connect with resources that support greater independence.
Our service and supports coordinators know that every individual and every family is different. We take a person-first approach, helping you understand your options and manage the next steps. Whether you are beginning the waiver process, trying to understand which Pennsylvania program may apply to your situation or already receiving services and need support coordinating them, Bridge is here for you. With the right resources, independence is within reach.
If you have questions about Medicaid Waiver programs, Act 150, or services available in Pennsylvania, contact A Bridge to Independence. We’re here to help you find your way forward.
