The Medicaid Home and Community-Based Services (HCBS) waiver program is federally authorized in §1915(c) of the Social Security Act. The program permits a State to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waiver’s target population. Waiver services complement and/or supplement the services that are available to participants through the Medicaid state plan and other federal, state and local public programs as well as the supportive services that families and communities provide.
The Centers for Medicare & Medicaid Services (CMS), a federal agency overseeing HCBS, recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the State, service delivery system structure, State goals and objectives, and other factors.
As mentioned, the HBCS Waiver program provides long-term supportive care services to qualified individuals who wish to remain in their home and/or community rather than enter an institution (such as a nursing home). Individuals who qualify for a HCBS Waiver Program must also receive full benefits through Medical Assistance (MA).
MA (Medicaid program) is public health care coverage for low-income families, older adults, and people with disabilities. In order to qualify, individuals must fit into a “covered group” (i.e., persons with a permanent disability or persons over 65 years old) and then meet the income and resource requirements of that group. Once they qualify, individuals get a certain package of medical benefits. MA can be someone’s only health insurance or their secondary insurance.
Waiver programs provide certain medical and non-medical services to individuals in their home in order to help them remain living independently in the community (which is the preference of most individuals). These services provided under the various programs are often 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 one qualifies for and the service plan that is developed to address the individual’s needs.
Funding for HBCS Waivers come from monies waived or diverted from skilled nursing facilities for those individuals who meet the same criteria in their level of care, but who again, wish to reside in their own homes independently with the support of personal care attendants, transportation and other services, as determined necessary.
In Pennsylvania, HCBS Waiver programs differ in terms of the population they serve, the number of people they can serve, the application process, the criteria they must meet for eligibility, and the overall services that may be provided. Determining one's eligibility can be a difficult when including all the above factors. See "How to Enroll" under SERVICES to find out the eligibility process in Pennsylvania.
The Pennsylvania Department of Human Services/DHS administers multiple Medical Assistance/Medicaid waivers. Each waiver has its own unique set of eligibility requirements and services. Service Coordination of South Central Pennsylvania, Inc. (SCSCPA) addresses five of these Waivers and one State Program to service adult with physical disabilities or autism.
Our Waiver Services include the following:
You may click any link above to learn more about the waivers provided through Service Coordination of
South Central Pennsylvania, Inc.
Please note all waiver information is from the Pennsylvania Department of Human Services Website