Overview
We all deserve our independence. The Community Living Waiver might be able to help you achieve yours.
The name “waiver” means the federal government waives Medicaid rules for institutional care so the state government can use the same money to provide support for people who need services closer to home in their own communities.
What services are covered?
The Community Living Waiver provides a variety of services that promote community living, employment, communication, self-direction, choice, and control. They include but are not limited to:
- Job Finding and Job Coaching
- Assistive Technology
- Behavioral Support
- Benefits Counseling
- Community Participation Support
- Consultative Nutritional Services
- Education Support
- Family/Caregiver Training and Support
- In-Home and Community Support
- Respite
- Shift Nursing
- Case Management/Supports Coordination
- Transportation
- And more
Eligibility
If you are enrolled in Medicaid, you may be eligible for the Medicaid Community Living Waiver for services supporting autism, intellectual disability, or developmental disability.
To be eligible for the Community Living Waiver, you must meet the following requirements:
Level of Care
- You must have a medical evaluation.
- You must receive a diagnosis of an intellectual disability, developmental disability, or autism.
Diagnosis Age requirements
- Individuals of any age with an intellectual disability (ID) or autism.
- Children with a developmental disability under age 9 with a high probability of resulting in an ID or autism diagnosis.
- Individuals under age 22 with a developmental disability due to a medically complex condition.
Other Requirements
- Recommended for an intermediate care facility (ICF) level of care based on a medical evaluation.
- Found eligible for Medicaid in Pennsylvania.
- Meet the financial requirements determined by your local County Assistance Office (CAO)
- Individual cost limit of $85,000 per person per fiscal year (does not include supports coordination)
Frequently Asked Questions
Visit ODP’s website to find useful information about available services and supports.
Each waiver has a limited number of people that can be served. There are waiting lists to enroll in waiver services. Priority for waiver enrollment is given to people with the most emergent needs.
All individuals with an intellectual disability and other individuals who meet waiver eligibility requirements will receive case management services, referred to in ODP as Supports Coordination. County MH/ID Programs also have limited funding to provide services through block grants or state funding referred to as base funding.
School age children receive most needed services through other programs such as Medicaid, their school district, and the Office of Vocational Rehabilitation. Children who need services not covered through other programs can receive services through a waiver.