Medicaid Waiver: What It Is and How to Use It

Home care is an ideal way for elderly individuals and those with a disability to age in place in the friendly atmosphere of a familiar community. However, at-home care services can be expensive. Fortunately, Pennsylvania and other states offer a waiver program that makes care more accessible.

Find out what the program entails and how to use it.

What is the Medicaid Waver?

The Medicaid waiver provides in-home and community services to the elderly and people with disabilities who would otherwise require institutional care. These programs allow them to live independently in the comfort of their homes, offering personal and respite care as well as home modifications.

It is called a waiver because it allows states to waive certain Medicaid rules to support at-home services. In this sense, it acts as a type of exemption. Although it reduces the cost of at-home care, recipients still pay the difference between the actual cost and the coverage.

The state of Pennsylvania offers different types of waivers as follows:

• Attendant Care Waiver: For disabled individuals who need assistance at home.
• OBRA Waiver for individuals with developmental disabilities who require support to function in their communities.
• Independence Waiver for people with severe physical disabilities who need help with independent living.
• Home and Community-Based Service Waiver assists people 60 and over so they can live in their homes and communities.

Who Qualifies for the Medicaid Waiver?

You can qualify for the Medicaid waiver if you meet the following criteria:

• Medical Condition: You may be qualified if you have a chronic health condition that requires long-term care.
• Financial Eligibility: You must meet certain income and asset limits set by the state.
• Medical Necessity: You must demonstrate a need for long-term home care or community services.
• Age: Some waivers, like the home and community-based service waiver, require you to be 60 or over.

What Services Does the Waiver Cover?

The services offered by the waiver vary but may include:

• Personal care
• Respite care
• Home and community-based services
• Home modifications
• Assistive technology
• Supported employment

How Do You Apply for the Waiver?

There are three options for completing the waiver application process as follows:

1.    Apply online: Visit the Pennsylvania Department of Human Services website to complete the online form and apply for services.

2.    Contact a Local County Assistance Office: You may also locate your local county assistance office and call the phone number or make an in-person appointment to apply.

3.    Apply through a Care Agency: A Medicaid-approved care agency can help you process the forms and provide care directly, supporting a seamless process.

A + Can Help You Apply

A+ is a Medicaid-approved provider that can assist you with the enrollment process. We will walk you through ensuring all needs are explained, help you select the best providers, and follow up with state agencies to ensure your application gets the required attention. We are also a top choice for in-home care, providing skilled workers and a wide range of personal and home health care services.

Contact us for affordable at-home care that will improve your quality of life.

FAQ

Does Medicare Cover In-Home Care in PA?

Medicare may provide in-home care for seniors and people with disabilities. However, it is not included in the PA waiver program.

What are My Payment Options?

Individuals receiving waiver programs can make payments as follows:

• Cost Sharing: The recipient is responsible for a portion of at-home care costs.
• Send-Down: The individual will pay a portion of the cost to an administrator or directly to the provider.
• Estate Recovery: The program may recoup costs from the deceased’s estate.