The Federal government permits states to waive certain Medical Assistance (MA) program requirements in order to provide home and community based services (HCBS) to specific groups of clients. HCBS Programs are an alternative to institutional or extended inpatient hospital care. HCBS Programs are sometimes called Waiver Programs. Both terms mean the same thing. Except for the Aging Waiver, which is administered by the Pennsylvania Department of Aging (PDA), all HCBS Programs are made available through one of the Department’s various Program Offices. 55 Pa. Code § 178.1 55 Pa. Code § 178.2
HCBS Programs allow the Department to provide medical benefits to an individual who may not otherwise qualify for MA. HCBS Programs may also provide services which are not normally covered by MA. HCBS Programs are available to an individual as long as the estimated cost does not exceed the cost of institutional or inpatient care.
The Department of Human Services (DHS) will make a payment towards the cost of Long-Term Care (LTC) services for an individual who is eligible for MA/LTC. An individual must be both medically and financially eligible to receive payment.
A HCBS provider agency, the Independent Enrollment Broker (IEB), a local Area Agency on Aging (AAA) office, or a local MH/MR agency is responsible for determining an individual’s medical eligibility for MA/LTC services.
The County Assistance Office (CAO) is responsible for determining financial eligibility for MA/LTC services.
The determination of financial eligibility is a two step process. Throughout the LTC Handbook there are references to STEP 1 and STEP 2. In STEP 1, the CAO will determine eligibility for MA/LTC for both LTC facility services and HCBS. In STEP 2, the CAO will determine the amount of the individual’s payment towards the cost of LTC facility services. There is no payment from the individual towards the cost of HCBS services.
See LTC Handbook Chapter 404, Application, for policy and procedures regarding application for HCBS programs. The policy and procedures in this chapter apply to the HCBS programs listed here as well as to MA/LTC services provided in a facility.
See LTC Handbook Chapter 440, Resources, Chapter 450, Income, and Chapter 468 Eligibility and Payment when determining eligibility for HCBS programs. The policies and procedures in these chapters apply to the HCBS programs listed here as well as to MA/LTC services provided in a facility.
In addition to the requirements of the LTC Handbook, the requirements of the following chapters of the Medical Assistance Handbook apply to an individual in a HCBS Program:
304, Application.
320, Identity.
321, Age.
322, Citizen/NonCitizen
338, Medical Assistance Benefits.
352, Self Employment.
370, Reporting Changes.
376, Renewal.
378, Verification.
380, Issuing the ACCESS Card.
387, SS.
392 Institutions.
The Commonwealth of Pennsylvania offers the following HCBS programs:
42 U.S.C. § 1396.(d)(a)(xvii) 42 U.S.C. § 1396n(i)(1)
Updated January 12, 2015 Replacing March19, 2012,