Pennsylvania Medicaid Waiver Guide

Understanding Pennsylvania Medicaid

Pennsylvania currently has four waivers that serve children, all of which are home and community based 1915(c) waivers. All waive parent income when determining eligibility. See Pennsylvania’s Medicaid Waiver page for more information. Pennsylvania also has a state-based program that is much like a TEFRA program and provides coverage to any child in the state with a disability.

Types of Programs

Consolidated Waiver

• Description from medicaid.gov: Provides community participation support, education support services, homemaker/chore, in-home and community support, residential habilitation, respite, supported employment, supports coordination, specialized supplies, therapy services, supports broker services, advanced supported employment, assistive technology, behavioral support, benefits counseling, communication specialist, companion, consultative nutritional services, family medical support assistance, family/caregiver training and support, home accessibility adaptations, housing transition and tenancy sustaining services, life sharing, music therapy/art therapy/equine assisted therapy, participant-directed goods and services, remote supports, shift nursing, small group employment, supported living, transportation, and vehicle accessibility adaptation services to individuals with autism ages 0 or older, individuals with developmental disabilities ages 0-21 years, and individuals with intellectual disabilities ages 0 or older who meet an ICF/IID level of care.
• Online State Information: Consolidated Waiver
• Official Federal Information
• How to Apply: Call the Customer Service Hotline at 1-888-565-9435 or contact your county Mental Health / Intellectual Disabilities Office.

Person/Family Directed Support

• Description from medicaid.gov: Provides community participation support, education support services, homemaker/chore, in-home and community support, respite, supported employment, supports coordination, specialized supplies, therapy services, supports broker services, advanced supported employment, assistive technology, behavioral support, benefits counseling, communication specialist services, companion, consultative nutritional services, family medical support assistance, family/caregiver training and support, home accessibility adaptations, housing transition and tenancy sustaining service, music therapy/art therapy/equine assisted therapy, participant-directed goods and services, remote supports, shift nursing, small group employment, transportation, and vehicle accessibility adaptation services to individuals with autism ages 0 or older, individuals with developmental disabilities ages 0-21 years, and individuals with intellectual disabilities ages 0 or older who meet an ICF/IID level of care.
• Online State Information: Person/Family Directed Support
• Official Federal Information
• How to Apply: Call the Customer Service Hotline at 1-888-565-9435 or contact your county Mental Health / Intellectual Disabilities Office.

Community Living Waiver

• Description from medicaid.gov: Provides community participation support, education support services, homemaker/chore, in-home and community support, life sharing, respite, supported employment, supports coordination, unlicensed residential habilitation, specialized supplies, therapy services, supports broker service, advanced supported employment, assistive technology, behavioral support, benefits counseling, communication specialist services, companion, consultative nutritional services, family medical support assistance, family/caregiver training and support, home accessibility adaptations, housing transition and tenancy sustaining service, music therapy/art therapy/equine assisted therapy, participant-directed goods and services, remote supports, shift nursing, small group employment, supported living, transportation, and vehicle accessibility adaptation services to individuals with autism ages 0 or older, individuals with intellectual disabilities ages 0 or older, and individuals with developmental disabilities ages 0 to 21 years who meet an ICF/IID level of care.
• Online State Information: Community Living Waiver
• Official Federal Information
• How to Apply: Call the Customer Service Hotline at 1-888-565-9435 or contact your county Mental Health / Intellectual Disabilities Office.

Medicaid Waiver for Infants, Toddlers and Families

• Description from medicaid.gov: Provides special instruction for individuals with intellectual disabilities and developmental disabilities ages 0-2.
• Online State Information: Infants and Toddlers and Families Waiver
• Official Federal Information
• How to Apply: Call 717-346-1119, or call the Customer Service Hotline at 1-888-565-9435, or contact your county Mental Health / Intellectual Disabilities Office.

PH-95

• Description: Medicaid coverage only.
• Online State Information: See this overview from the state (scroll down to 305.292 PH) or this independent guide on the PH-95 Category.
• How to Apply: Apply for Medicaid using a paper application or online.

Other online resources for Pennsylvania:

• Overview of Pennsylvania waivers
• The Autism Services, Education, Resources, and Training Collaborative (ASERT) has great information for Pennsylvanian residents and resource specialists you can contact.
• Special Kids Network (SKIN) can help you access local services and supports
• PA Families inc connect parents and families in Pennsylvania

Telephone Resources

ASERT resource specialists: 877-231-4244

Ordering Goally with a Medicaid Waiver

Talk with your case manager to see if the waiver program you have will cover Goally. If so, have your case manager email us at: [email protected] to place an order on your behalf.