“Medicaid Waiver” What is it? Do I qualify? How do I get started?

Posted on August 14, 2018 by lawp873

The name waiver comes from the fact that the federal government “waives” Medical Assistance/Medicaid rules for institutional care in order for Pennsylvania to use the same funds to provide supports and services for people closer to home in their own communities.

When trying to pay for senior home care the Aging Waiver is where a lot of people focus. The Aging Waiver is designed to help people who are age 60 and older who have been assessed and require services at the level of nursing facility care, needing assistance with activities of daily living (ADL’s) and have a financial need. If an individual qualifies physically and financially the Aging Waiver provides funds to pay for in-home care.

In Pennsylvania, the Department of Human Services administers multiple Medical Assistance/Medicaid waivers. Each waiver has its own unique set of eligibility requirements and services.

Waivers offer an array of services and benefits such as choice of qualified providers, due process, and health and safety assurances.

Currently, Pennsylvania has many waiver programs that are designed for specific needs including:

Aging Waiver
Attendant Care Waiver
Independence Waiver
OBRA Waiver
Act 150 Waiver

The First Step:

The first step in applying for the Aging Waiver is to contact Pennsylvania’s Independent Broker (PA IEB)

The IEB will provide the path you need to follow to determine financial eligibility and physical eligibility. If you qualify the IEB will provide you a list service coordinators you will choose from and they will provide you with a list of home care agencies to choose from. Then you can begin home care. The Team is made up of three parts: you, the client, the Service Coordinator and the Home Care Agency. You the client have the ongoing option to change and choose different Service Coordinator and Agency to best fit your needs. For example, if you are working with an agency that you are not happy with you can switch to Loving Arms Elder Care who is an approved Aging Waiver provider.

A decision about whether you qualify will be sent to you within 90 days after PA IEB starts your waiver application. If you do not get a decision within 90 days, you can ask for a fair hearing.

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