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This guide provides an overview of the waiver and non-waiver services available for individuals within the Developmental Disabilities (DD) system. It outlines the four categories of individuals eligible for these services (SC Only, Base, PFDSW, and Consolidated Waiver), the roles of Supports Coordinators, and how they assist families in locating and coordinating needed services. Additionally, it details the eligibility criteria for waiver funding, including income limits and service caps, as well as the array of services available, such as assistive technology, transportation, and employment programs.
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Non-Waiver and Waiver Services Services in the Developmental Disabilities (DD) System
Four Categories of Individuals in the DD System • SC Only • Base • PFDSW (Person/Family Direct Support Waiver) • Consolidated Waiver
SC Only and Base • Supports Coordinator (SC) will locate, coordinate and monitorneeded services. • Locating – helping finding community programs, medical professionals, etc. • Coordination - helping the family navigate other service systems, such as the Medical Assistance system. • Monitor – monitor health and safety.
Sources of Funding The Federal Government CMS – Centers for Medicare and Medicaid Services The Commonwealth of PA Both independently and in conjunction with CMS
Person/Family Direct Support Waiver (PFDS/PFDSW) Consolidated Waiver Waiver Funding
Waiver Eligibility Person/Family Direct Support Waiver • Be age three and older • Have a diagnosis of mental retardation • Require active treatment • Be recommended for an intermediate care facility level of care based on a medical evaluation • Determined eligible for Medical Assistance (MA) • $2,000 resource limit (does not apply to dependent children under age 21) • Income limit 300% of the Federal Benefit Rate • Individual cost limit of $30,000 per person per fiscal year (excluding supports coordination) • Does not require Office of Developmental Programs licensed community residential services Consolidated Waiver • Be age three and older • Have a diagnosis of mental retardation • Require active treatment • Be recommended for an Intermediate Care Facility level of care based on a medical evaluation • Determined eligible for Medical Assistance (MA) • $2,000 resource limit (does not apply to dependent children under age 21) • Income limit 300% of the Federal Benefit Rate
Waiver Funding • Services provided by waiver are based on Need. • Need is determined through the PUNS (Prioritization of Urgency of Needs for Services) • PFDSW - all needs must be met under the $30,000 cap (not including Supports Coordination) *no residential services* • Consolidated Waiver – no cap for services
What Services can Waiver Funds Buy? • Assistive Technology • transportation • home adaptations • housing • nursing respite • vehicle adaptations • day programs • Habilitation/ Companion • job coaching
Housing/Residential • Supported Living • LifeSharing • Residential • CLA *Waiver funded • ICF/DD *State funded (Oversight by DOH)
Day Programs/Employment Opportunities to earn money Opportunities to develop skills • Community Base • Work Activity Center (WAC) pre-vocation • Transitional Employment Programs (TEP)/Enclave • Competitive Employment • Adult Training Facilities (ATF)* • Senior Centers • Adult daycare • Volunteering
