How Medicaid Waivers Help Children with Disabilities in Pennsylvania

In Pennsylvania, Medicaid waivers play a crucial role in enabling individuals with disabilities to receive personalized, community-based services as an alternative to institutional care. The requirement that services be provided in an institutional setting has been waived. This approach promotes independence and community integration for individuals with disabilities. These waivers, administered by the Pennsylvania Department of Human Services (DHS), have undergone significant updates over recent years to serve participants’ needs better.

Waiver services are essential for individuals with disabilities who live in the community. These services often include more than just nursing and medical care; they also support coordination, vocational training, and other similar services. These waivers are usually a critical lifeline for the disabled person, their family, and their caregivers.

Types of Waivers Available in Pennsylvania

As of 2025, Pennsylvania offers numerous waiver programs for children and adults with disabilities. Some of the most used programs for families with children living with disabilities include:

Person/Family Directed Support (P/FDS) Waiver

Designed for individuals with intellectual disabilities or autism, this waiver provides services to support community living and enrichment. The individual generally can reside in a small residential care setting. This waiver often includes the ability to seek self-directed services as well as agency-driven services. It has an annual spending limit of $47,000 per individual, with the ability to include up to $15,000 more if needed under certain circumstances.

Community Living Waiver (CLW)

This waiver supports individuals with intellectual disabilities or autism, offering services that promote community living and independence. The individual must live in the community, not a residential care facility. A key aspect of the program is the support living assistance, which seeks to enable the individual to remain in the community. The individual may receive up to $97,000 per year in services.

Consolidated Waiver

Aimed at individuals with intellectual disabilities, autism, and other significant limitations, the Consolidated Waiver offers comprehensive services to support community living, including residential services. It is the “gold standard.” Unlike other waiver programs, there typically is no funding or expenditure limit with this waiver, which can provide nearly all services to individuals with significant needs.

Adult Autism Waiver

Specifically for adults over 21 with autism, this waiver provides services to help individuals live independently in their communities. The goal is to increase independence and employment, while reducing stress on families, and reducing the likelihood of problematic episodes. The current cap on spending per participant is $10,000.

Children’s PH-95 Waiver

This program provides coverage for children under 18 who have extensive needs because of their disability. The program primarily supports children with autism, developmental disabilities, and complex medical needs. A unique aspect of this waiver is its eligibility requirements. It is only available to children under 18. Unlike other programs, the child has no asset or income limit.

Likewise, and critically, the parents’ assets or income are not considered while the child is under 18. This allows children in households with significant assets or income to qualify for the care and services they need. Participants enroll in a plan that serves their region. This waiver can often be used as a supplement to a parent’s work-sponsored plan, covering most of the provider copays.

Services Provided Through Waiver

Generally, each waiver provides services and support coordination to ensure the beneficiaries achieve the program’s goals. The services often include various therapies, medical care, nursing care, assistance with ADLs, day programs for adults, and funding for home or vehicle modifications. Each waiver offers a variety of home and community-based services, but the specific services included differ from one waiver to another. Every waiver program contains detailed service definitions that vary across waivers. Individuals or their caregivers must ensure that the services the disabled person needs are provided by the specific waiver they seek.

Effective January 1, 2025, DHS introduced new services and modified existing waivers. For example, some waivers now include chore services to ensure basic household tasks are completed. Other waiver programs are now authorized to pay for teleservices, such as virtual rehab, counselling, and therapy sessions, greatly expanding access to this care.

Ongoing Eligibility and Enrollment

Like most Medicaid programs, eligibility for these waivers typically requires a diagnosis of an intellectual disability, autism, developmental disability, or other qualifying disability, along with meeting specific level-of-care criteria. Additional financial criteria, such as income and resource limits, exist for enrollment into these programs.

Individuals with waivers and their families should be aware of the eligibility requirements. While many disabled individuals will not outgrow their disabilities, that is no reason to let one’s guard down. The financial eligibility requirements are ongoing. To ensure continuing eligibility for waivers and the services they provide, recipients must maintain their financial eligibility and comply with redeterminations commanded by the agency.

If an individual is Medicaid-eligible, they often can switch between waiver programs. For example, individuals who may have increasing care needs could switch from the Autism Waiver to the Consolidated Waiver, assuming they meet the ongoing eligibility requirements.

Maximizing the Benefits of Medicaid Waivers in Pennsylvania

Pennsylvania’s Medicaid waivers have evolved to offer a broader range of services and support, empowering individuals with disabilities to lead more independent and fulfilling lives within their communities. Staying informed about these updates is essential for participants and their families to maximize the benefits available to them. Fill out an online form now to hear from our attorneys with any questions.

This material is intended to offer general information to clients and potential clients of the firm, which is current to the best of our knowledge on the date indicated below. This information is general and should not be taken as specific legal advice applicable to a particular situation. METTE assumes no responsibility for any individual’s reliance on the information disseminated unless that reliance results from the firm’s specific recommendation to a client as part of our representation of said client. Please note that changes in the law occur and that information contained herein may need to be verified occasionally to ensure accuracy. This information was last updated in May 2025.