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Frequently Asked Questions

 

FAQ 2: Medicaid Home and Community Based Waiver Programs

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Waivers, segments 10-19:

Listen to segments 1-9

Am I entitled to apply for Waiver funding?


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Yes. If you are 3 years old or older and eligible for Intellectual Disabilities/Mental Retardation (ID/MR) services, you are entitled to apply for Waiver. The Waiver application only determines your preliminary eligibility to receive Waiver funding. It does not mean you will be enrolled and get Waiver funding. If you believe you are denied the opportunity to apply or are denied eligibility for any reason, you have the right to appeal.


What if I am eligible, but they have no money for me?


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If you are preliminarily eligible for a Waiver, but there is no funding available for you, you will be added to the Waiting List. Anyone who will need supports and services in the next five years should complete a Prioritization of Urgency of Need for Services (PUNS) form. This form is used by the AE/County and the state to track how many people are waiting for support, and what types of support are needed.

Unfortunately, there are many people across the state waiting for supports and services. There are some things you can do while you wait. You can use community supports, such as YMCA, church groups, advocacy agencies, and other groups that may have volunteers or programs to meet some of your needs. Additionally, some counties have limited Base funding or Family Driven Support Services (FDSS) funding that may help meet some of your needs. These services and supports should be outlined in an Individual Support Plan (ISP). You should discuss available resources with your Supports Coordinator (SC) while you are waiting for Waiver enrollment. An honest discussion of your needs is critical to obtaining resources. Be honest about what you need and why you need it. You will not be "at the table" when funding decisions are made at the AE/County and state offices, so your SC must have a good understanding of your needs to effectively advocate on your behalf.


When I am enrolled on a Waiver, am I entitled to services?


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Yes. If you are found eligible for a Waiver and you begin receiving Waiver services, then you are entitled to all of the services you need that are offered in that Waiver, as per your authorized Individual Support Plan (ISP).


What happens if I request a service and my supports coordinator or someone else on my support team tells me I cannot get that service?


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If you request a new service or a change in services and are told that it cannot be included in your ISP because your ISP team does not agree that you need the change in services or the new service, your Supports Coordinator (SC) can assist you in filling out the Waiver Service Request form (DP 1022).

The Waiver Service Request form is a formal request in which you will state what service you need, how much of it you need, and why you need it. Your SC should submit this form to the AE/County program within 10 days and the AE/County program should give you a formal approval or denial of your request within 20 calendar days of when they receive the form.


Is it possible to lose my waiver after I am enrolled?


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Yes, it is possible to lose your Waiver after you are enrolled. You must continue to meet all of the following criteria:

  • Eligibility for for Intellectual Disabilities/Mental Retardation services
  • Intermediate Care Facility for People with Mental Retardation (ICF/MR) Eligibility—This means that you need the same level of care as someone who would otherwise receive services in an institution. You must also continue to need "Active Treatment." This means that you need at least one on-going service that is covered under the Waiver.
  • Financial Eligibility—There are income and asset limitations to qualify for a Waiver. If you are working, be sure to remember those limits. Contact your Work Incentive Planning Assistance Program (WIPA) if you anticipate increases in wages.

The County Assistance Office (CAO) does an annual financial eligibility re-determination that covers both your Medical Assistance and Waiver. They will look at your income and any assets you have and make sure that you still qualify. Annually, the AE/County will ask you to have a medical evaluation by your physician regarding your disability to ensure that you still meet the Intellectual Disabilities/Mental Retardation and ICF/MR eligibility standards.


What do I do if I have a problem?


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You have a few options to address specific problems. You can set up a meeting with your Supports Coordinator, the Supports Coordinator Supervisor, and/or the Administrative Entity (AE)/County. You should document all meetings and phone calls. All decisions concerning Intellectual Disabilities/Mental Retardation (ID/MR) services should be put in writing to you. If you have not received written documentation regarding ID/MR services, request the documentation from your AE/County. You could also contact your Regional ODP Manager, or call the ODP toll free customer service number—1-888-565-9435. Advocacy organizations may be able to help you or offer specific information about your situation.

If you are enrolled in a Waiver, you have the right to Fair Hearings and Appeals for certain issues. You should receive a copy of all your rights at your annual meeting, and any time you request a copy. If your services are denied, reduced, suspended, or terminated, the AE/County must notify you in writing. It is important to act quickly if you disagree with a change in your services. If you file the appeal within the 10 day window, services that are on-going will continue. One-time services or services that have not started do not need to be provided. When you file for Fair Hearing, you will automatically have a "Service Review." Service Review is a 15-day process in which your situation is reviewed by the Regional ODP Office in an attempt to reach a quick resolution. If you disagree with this review, you will proceed to Fair Hearing and Appeal. ODP Bulletin 00-08-05 Due Process and Fair Hearing for Individuals with Mental Retardation explains all of your rights as a Waiver participant.


Where do I go if I need help?


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The Pennsylvania Training Partnership for People with Disabilities and Families (The Partnership) can provide you with a copy of Understanding Office of Developmental Programs in Pennsylvania: Mental Retardation and Autism Services. Known as the "Gold Book," this publication has detailed information about the Intellectual Disabilities/Mental Retardation system, copies of important forms, descriptions of the services available through the Waivers, advocacy group contact information, and checklists for families to use as they navigate the system. It is free to people with disabilities and their families. Please contact The Partnership at 1-866-865-6170 for a copy. It is also available on The Partnership website, www.TheTrainingPartnership.org.

The State Office of Developmental Programs has a toll free phone number for you to call if you have questions about the Waiver programs, the services available, or the choices you have in directing your own supports. ODP's toll free number is 1-888-565-9435. Additionally, The Partnership and its participating agencies can answer questions and offer assistance to individuals or their families.


LINKS TO RESOURCES


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The State Office of Developmental Programs has a toll free phone number for you to call if you have questions about Waivers.


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Additionally, The Partnership and its participating agencies can answer questions and offer assistance to individuals or their families.

Office of Developmental Programs 1-888-565-9435


ODP Regional Point People (as of Summer 2011):

Central
John Witt
Tel: 717-772-6507
Email: jwitt@state.pa.us

Northeast
Robert Conklin
Tel: 570-963-4749
Email: rconklin@state.pa.us

Southeast
Vicki Stillman-Toomey
Tel: 215-560-2242
Email: vstillmant@state.pa.us

Western
Sandy Schalcosky
Tel: 412-565-5144
Email: cschalcosk@state.pa.us


The Partnership

Tel: 1-866-865-6170
Web: www.TheTrainingPartnership.org

The Partners:

Achieva
Tel: 412-995-5000
Toll free: 1-888-272-7229
Web: www.achieva.info

Mentors for Self Determination
Tel: 814-547-1577
Web: www.mentors4sd.org

Self-Advocates United as 1
Tel: Eastern, 215-923-3349 x132
Tel: Western, 724-813-5702
Toll free: 1-877-304-7730
Web: www.sau1.org

Vision for Equality
Tel: Philadelphia, 215-923-3349
Tel: Harrisburg, 717-233-2424
Web: www.visionforequality.org

Institute on Disabilities at Temple University
Tel: 215-204-7556
Toll free: 1-866-865-6170
Web: www.disabilities.temple.edu


THE PARTNERSHIP


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THE PARTNERSHIP—The Pennsylvania Training Partnership for People with Disabilities and Families

  • Achieva
  • Institute on Disabilities
  • Mentors for Self Determination
  • Self-Advocates United as 1
  • Vision for Equality

The Partnership is funded by the Office of Developmental Programs, Department of Public Welfare.

Phone: 1-866-865-6170
Web: www.TheTrainingPartnership.org

Providing training and technical assistance in Pennsylvania.

Produced by the Institute on Disabilities at Temple University, College of Education.

This information is available in alternate formats, upon request.

Para información en español: 215-204-9348 o por correo electrónico al: latino@temple.edu.