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Welcome to the comprehensive guide on how to apply for a waiver program in Pennsylvania, brought to you by OneWell Health Care. Navigating the process of obtaining waiver funding can be complex, but we’re here to provide you with a step-by-step breakdown to help you understand and navigate each stage effectively.

In Pennsylvania, accessing waiver programs administered by the Office of Developmental Programs (ODP) involves several essential steps. From obtaining a Supports Coordinator to completing the necessary paperwork and waiting for a waiver slot, our guide covers everything you need to know to get started on your journey to securing vital support services for yourself or your loved one.

Please follow along as we outline each step in detail, ensuring you have the information and resources necessary to navigate this process with confidence. Whether you’re a participant or a family member seeking assistance, our goal is to empower you with the knowledge needed to access the services you deserve.

5 Steps to Apply For a Waiver Program in PA

Step 1: Getting a Supports Coordinator

To begin the process to get on an ODP Waiver in Pennsylvania, you will need a supports coordinator. The steps outlined below explain how to get your supports coordinator:

A. Contact your local Mental Health and Developmental Services (MH/DS) program office. These offices are county specific. You can find a list of MH/DS program offices here.

B. Ask your local MH/DS program office for an intake. The intake worker will contact you to begin the paperwork process that will need to be completed and/or submitted to them prior to the intake assessment:

  • Required documentation will include a Full-Scale IQ Test that is signed off by a Licensed Psychologist as well as an Adaptive Behavior Scale. The Full-Scale IQ should document an IQ of 70 or below. In the case of someone with just autism, whose IQ may be higher than 70, then they will also need to show more than 30% deficit in at least two life domains (this can include socialization, personal care, and more). Documentation should be completed prior to contacting the MH/DS program office. If you do not know of a psychologist that is familiar with these reports, your local county office will be able to recommend a psychologist to you.
  • If the participant is of school age, an IEP will be required during the intake process.
  • Other required documents include: Any previous Doctor reports, any previous evaluations, Social Security Number, Birth Certificate, State Issued Identification Card (if they have one), etc.

C. Once submitted all required documentation to the intake worker, the intake worker will then review:

  • If you are found not eligible, the intake worker will issue a letter denying eligibility. The family does have the right to file a fair hearing and appeal the eligibility decision.
  • If you are found eligible, the intake worker will contact you to schedule the actual intake assessment. This assessment can take between two and three hours. This assessment will go over many questions including but not limited to: What are the needs of the individual? What are specific diagnosis? Are there any behavioral issues? Any medical issues? Family History, etc.

D. After the intake assessment is completed, the intake working will provide the family with a listing of all support coordinator organizations available to you. The family has the freedom of choice to choose the SCO they would like to work with. The intake worker will not be able to recommend an SCO to the family, but the family is able to contact SCOs directly to ask them questions. We recommend families choose their SCO based on what is most importation to them. For instance, the distance to their office from the participants home, how long the SCO has been in operation, size of the SCO, etc.. After choosing the SCO, the family also has the choice to change SCOs at any time if they are not happy with their current SCO.

E. Once the family has selected the SCO they would like to work with, the SCO will assign the Participant a Supports Coordinator.

Step 2: Individual Support Plan Meeting & PUNS (Priority of Urgency of Need for Services)

A. Once you have been assigned a Supports Coordinator (SC) through your SCO, the SC will schedule and complete an Initial Individual Support Plan (ISP) meeting. This meeting will cover a lot of similar questions that were asked during intake. This meeting will be used to create the ISP specific to the goals and needs of the Participant and Family.

B. After the initial ISP meeting, the SC will place the participant on a PUNS. The PUNS is similar to a waitlist, but it is not in numbered order. This list is based on need and there are three separate categories.

  • Emergency: Need your waiver right now or within the next six months. (Example: Graduating High School within six months or has an aging caregiver).
  • Critical: On waiver in six months through two years. (Example: Graduating High School within two years).
  • Planning: On waiver in two to five years or two years and beyond. (Example: May have a change in need but are not sure yet).

C. Once an individual turns 21, they will lose all their entitlement services such as education, EPSDT benefits (nursing or home health aides), and behavioral health services through their insurance. This is where the waiver program would pick up and begin providing those services they may not be lacking. It is important to get on PUNS prior to turning 21 to lessen the time period the individual may go without services.

Step 3: Completing the Service Preference Form

A. The participant/family along with the Supports Coordinator will complete a Service Preference Form, also known as a DP458. This document is a 2 page form that will give you the choice of services either through the Home and Community Based Waiver or services in a State facility such as a Residential Campus.

B. The SC will then complete a letter of need going over what the participant will need from the waiver. This may not necessarily be what the participant wants, but what they truly need. For example, a day program or transportation. This information will be used in tandem with the ISP to ensure that the services are truly reflective of the individuals and family’s needs.

C. When choosing individuals to give waiver slots to, they are not just looking at the needs of the individual but also the needs of the family. For instance, if the individual does not get the waiver to cover his day program and transportation, what will happen? Will the family member lose their job therefore resulting in unpaid bills? Are the parents going through a divorce and it is causing a family stressor? Etc. Although this is sensitive information, we encourage the families to share so that the best possible services can be provided to their loved one.

Step 4: Waiting for a Waiver Slot

Each County meets to discuss the current PUNS list to select individuals based on need to fill any Waiver openings they may have.

  • Waiver slots become available if an individual on the waiver passes away, moves out of state (if moving withing the state of PA waiver services will not be lost), or chooses to no longer receive waiver services.
  • The state also has the ability to provide counties with additional waiver slots if they choose called waiver initiative (Ex. Aging Caregiver Initiative or Graduate Initiatives)
  • The state also holds 100 unanticipated emergency slots. These slots have very specific criteria and would mainly go to individuals who have experienced the sudden death of a primary caregiver, homelessness, to prevent incarceration, and more.

Step 5: Congratulations! A Waiver Slot is available for you.

A. Once a waiver slot is available for you, you will receive a letter that says funds are available for you from ODP.

B. Once receiving notification, you will have 45 calendar days to submit all needed paperwork, pick a Provider Agency (OneWell) for your support’s services, have supports coordinator put services into your plan, and have all paperwork approved by the county. Your assigned Supports Coordinator will assist you with this process.

Disclaimer: OneWell Health Care does not have the authority to select or assign waiver slots in the state of Pennsylvania. The guide provided is intended to help families better understand the steps required to obtain waiver funding. OneWell Health Care serves as a Provider Agency for services only after individuals have received waiver funding. It is recommended to consult with the appropriate state agencies for additional information regarding the application and allocation of waiver slots.