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Pennsylvania Medicaid Waivers & Home and Community Based Programs Overview

Updated: Mar 23

Pennsylvania, known as the Keystone State, has a robust Medicaid waiver system designed to support individuals with disabilities, seniors, and those with chronic illnesses by providing Home and Community-Based Services (HCBS) as an alternative to institutional care. The Pennsylvania Department of Human Services (DHS), specifically through the Office of Long-Term Living (OLTL) and the Office of Developmental Programs (ODP), administers a variety of waivers, including the Community HealthChoices (CHC) Waiver, Aging Waiver, Consolidated Waiver, and Person/Family Directed Support (P/FDS) Waiver.

Pennsylvania Medicaid waivers offer HCBS through CHC, Aging, Consolidated, and P/FDS waivers, supporting seniors and individuals with disabilities at home.

These programs offer services such as personal assistance, respite, assistive technology, and behavioral health support. Pennsylvania’s waiver system operates under a Managed Care model for long-term services, with Community HealthChoices (CHC) MCOs coordinating care for eligible participants while emphasizing Participant-Directed Care and Person-Centered Planning.


Regulatory oversight in Pennsylvania is complex and involves multiple state agencies, including DHS, the Department of Health (DOH) for licensing, and the Office of the Inspector General (OIG) for fraud prevention and compliance. Eligibility determinations and service coordination are managed through Independent Enrollment Brokers (IEBs), Administrative Entities (AEs), and County MH/ID programs. Pennsylvania has also implemented Electronic Visit Verification (EVV) requirements for home-based care services, reinforcing accountability and service integrity.


Additionally, provider enrollment, credentialing, and Medicaid reimbursement are governed by state-specific regulations that providers must navigate. Whether working with Community HealthChoices (CHC) Managed Care Organizations, Office of Developmental Programs (ODP) oversight, or the Medicaid Fee-for-Service model, a comprehensive understanding of Pennsylvania’s HCBS landscape is essential for compliance and operational success in the state.


 

Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.



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