Home and Community-Based Services (HCBS)
Long Term Care (LTC) services include both Home and Community Based Services (HCBS) and LTC Facility Services. A person who has a medical need for LTC services may choose which program to participate in. If a person applies for medical assistance and payment of LTC services, they must also meet the non-financial and financial medical assistance eligibility requirements.
Long-Term Care Facility Services
Long term care facilities, also known as nursing homes, provide both short and long term nursing and rehabilitation services for persons that require 24-hour care. A list of LTC facilities in Pennsylvania may be found via the PA Department of Health web site.
A person may also compare long term care facilities at Medicare.gov
Home and Community-Based Services
Home and community-based services are also known as waiver-funded services or waiver programs. The name waiver comes from the fact that the federal government "waives" medical assistance rules for institutional care in order for Pennsylvania to use the funds for HCBS. HCBS provides for supports and services beyond those covered by the Medical Assistance (also referred to as Medicaid) program that enables a person to remain in a community setting rather than being admitted to a Long Term Care Facility. Currently, the Department of Human Services administers 12 HCBS programs. Each HCBS program has its own eligibility requirements and services.
If a person is determined eligible for more than one HCBS program, the person cannot receive services under two or more such programs at the same time. The person must choose one HCBS program and receive the services provided by it.
A list of the available home and community-based programs and their associated eligibility requirements follows:
Functional Eligibility Requirements
Services Provided
- No age limit for intellectual disability or autism.
- Developmental disability with a high probability of resulting in an intellectual disability or autism are eligible from age 0 through 8
- Require an ICF/ID or ICF/ORC level of care
- Individual cost limit of $70,000 per person per fiscal year (Supports Coordination is excluded from this limit)
- Employment Services (job finding and job coaching)
- In-Home and Community Support
- Companion
- Community Participation Support
- Respite
- Shift Nursing
- Therapies
- Behavioral Support
- Assistive Technology
- Home and Vehicle Accessibility Adaptations
- Transportation
- Life Sharing
- Supported Living
- Age 21 or older with a physical disability
- Meet nursing facility level of care criteria
- Wish to receive long-term services and supports in own home or another community setting
- Age 18 through 59 (over age 59 conditional)
- Meet the level of care needs for a Skilled Nursing Facility
- Not financially eligible for Medicaid
- Have a medically determinable physical impairment that is expected to last of a continuous period of not less than twelve (12) calendar months or that may result in death
- Personal Assistance Services
- Personal Emergency Response System (PERS)
- Service Coordination
- 21 years or older
- Diagnosis of Autism Spectrum Disorder (Autistic Disorder, Childhood Disintegrative Disorder, PDD-NOS, Asperger Syndrome or Rett Disorder)
- Require Intermediate Care Facility (ICF) level of care
- Be able to live in a home or community setting without 16 hours or more per day of awake staffing and supervision
- Not have behaviors that are dangerous to yourself or others or that could cause harm to property
- Physician, ICF, psychiatric, nursing facility, hospice services
- Dental, vision, speech, podiatry, chiropractic services
- Medical supplies and equipment
- Health promotion and disease prevention services
- Targeted case management
- Mental health crisis intervention services
- Adult day habilitation services
- Homemaker services
- Residential & behavioral support
- Respite care
- Supported employment
- Community transition services
- Environmental modifications
- Assistive technology
- Family counseling
- Age 21 or older
- Diagnosed with Autism Spectrum Disorder (Autistic Disorder, Childhood Disintegrative Disorder, PDD-NOS, Asperger Syndrome or Rett Disorder)
- Meet Intermediate Care Facility level of care
- Assistive technology
- Behavioral health services
- Community inclusion
- Community Transition Services
- Counseling
- Day & residential habilitation
- Environmental modifications
- Family counseling & training
- Job assessment and finding
- Nutritional consultation
- Occupational therapy
- Respite
- Speech/ language therapy
- Supported employment
- Supports coordination
- Temporary crisis services
- Transitional work services
- Between birth and age 3
- In need of early intervention services
- Meet Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) or Intermediate Care Facility for Persons with Other Related Conditions (ICF/ORC) level of care
Habilitation, which is a service provided in-home and community settings to assist a child in acquiring, maintaining and improving self-help, domestic, socialization, and adaptive skills
- No age limit for intellectual disability or autism.
- Developmental disability with a high probability of resulting in an intellectual disability or autism are eligible from age 0 through 8
- Require an ICF/ID or ICF/ORC level of care
- Individual cost limit of $33,000 per person per fiscal year (Supports Coordination and Supports Broker are excluded from this limit. There are also some exceptions for employment service.)
- Employment Services (job finding and job coaching)
- In-Home and Community Support
- Companion
- Community Participation Support
- Respite
- Shift Nursing
- Therapies
- Behavioral Support
- Assistive Technology
- Home and Vehicle Accessibility Adaptations
- Transportation
- No age limit for intellectual disability or autism.
- Developmental disability with a high probability of resulting in an intellectual disability or autism are eligible from age 0 through 8
- Require an ICF/ID or ICF/ORC level of care
- No individual cost limit per year on services
- Residential Habilitation
- Employment Services (job finding and job coaching)
- In-Home and Community Support
- Companion
- Community Participation Support
- Respite
- Shift Nursing
- Therapies
- Behavioral Support
- Assistive Technology
- Home and Vehicle Accessibility Adaptations
- Transportation
- Life Sharing
- Supported Living
- Persons with developmental physical disabilities
- Disability results in at least 3 substantial functional limitations
- Disability manifested prior to age 22
- Age 18 or older
- Disability is expected to continue indefinitely
- Requires ICF/ORC level of care
- Daily living services
- Environmental adaptations
- Assistive technology
- Community integration services
- Respite services
- Transportation
- Supported employment services
- Prevocational and educational services
- Age 55 older
- Meet eligibility requirements for nursing facility level of care
- Able to safely live in the community with services available through the provider
- Reside in locations where services are available
- Adult day health services
- Transportation/ escort services
- Primary medical specialist care
- Nursing care/skilled nursing
- Dental, vision, podiatry, audiology care
- Social services/ case management
- Physical, occupational, speech therapies
- Recreational therapy
- Nutritional counseling/ education
- Laboratory/ diagnostic test, x-rays
- Pharmaceuticals
- Prosthetics, orthotics, durable medical equipment and supplies
- Psychiatric services
- Personal care
- Homemaker chore services
- Home delivered meals
- Hospital care/ hospice services
- Nursing facility services
- Services for hearing/speech impairments
- Translation services
