When can I start receiving service?

Within 24 hours of service authorization receipt from the office of the long term living or your service coordinators for waiver participants and upon sign up completion for private pay client.

My friends & relatives have been caring for me before waiver approval. Can they continue to care for me?

Absolutely, we will only process their information as we do for all employees, test for competency, hire and train or assist them to ensure that you are cared for
in the most effective way.

What are the types of HCBS Waiver programs?

Aging Waiver: For individuals age 60 & Older who have been assessed to require services at the level of nursing facility level of care.

Attendant Care Waiver:  For Individuals age 18 to 59 who have been assessed to require services at the level of nursing facility level of care.

COMMCARE Waiver: For Individuals age 21 and older with medically determined diagnosis of traumatic brain injury, TBI who have been assessed to require services at the level of nursing facility level of care.

Independence Waiver: For Individuals age 18 to 60 who have been assessed to require services at the level of nursing facility level of care.

OBRA Waiver: For Individuals age 18 to 59 who have a severe developmental physical disability requiring an Intermediate Care Facility/Other related Conditions (ICF/ORC) level of care

Act 150 Program: For Individuals age 18 to 59 who have been assessed to require services at the level of nursing facility level of care. This program may assess a minimum co-payment for services.

Living Independently for the Elderly (LIFE): For Individuals age 55 and older, LIFE is a managed care program that provides a comprehensive all-inclusive package of medical and supportive services. The program is known nationally as the Program of All-Inclusive Care for the Elderly (PACE). All of the PACE providers in Pennsylvania have the name ‘LIFE’ in their name.

What are the primary populations served by OLTL HCBS?

Adults with Physical disabilities and aging-related conditions who:

Meet clinical, functional and financial eligibility. Clinical eligibility is determined by the Area Agency on Aging and the Financial eligibility is determined by the County Area Office.

Have physical impairments. Congenital (E.g. Muscular dystrophy or cerebral palsy), A result of disease (Multiple sclerosis, heart disease, or pulmonary disease) or a result of Injury such as spinal cord injury or Traumatic Brain Injury.

May have hidden (non-visible) disabilities. Pulmonary disease, Respiratory disorders, Epilepsy, Dementia and Other limiting conditions.

Rely on assistive devices for mobility. Wheel chairs, Crutches, Canes, Artificial limbs.

What are the services for Adults covered by Medical Assistance:

  • Inpatient & Outpatient Hospital Services
  • Prenatal Care
  • Physician Visits
  • Nursing Facility Care
  • Family Planning Services & Supplies
  • Home Health Services
  • Laboratory & X-Ray

What is Third Party Liability (TPL)?

They are institutions that has legal obligation to pay all or part of the expenditures for the care of an individual eligible for Medical Assistance.
Medical Assistance is intended to be the payer of last resort, all other available third party must meet their legal obligation to pay claims before Medical Assistance pays for the care of an eligible individual.
TPL includes Medicare, Private Health Insurance, Employment Related Health Insurance, Court-ordered Health Insurance, Court Judgments/settlements from Liability Insurer, 1st Party Probate/Estate Recoveries, Workers’ Compensation, Long-term Care Insurance, Veteran’s Benefits, Other State & Federal Programs.

What are the services not funded by Waiver Programs?

Services public schools are expected to fund or pay
Room and Board
State Plan Services
Music/Art Therapy
Home Repairs/Adaptations
Institutional Services
Services provided by spouse/POA/Guardian

Am I eligible for waiver & how long does it take to get enrolled?

You have to meet clinical, functional and financial eligibility. If you do not
have an active Pa medical assistance, you can apply via compass.state.pa.us.
Complete financial eligibility application. Then call Maximus 877-550-4227.

Maximus will set up an appointment within 5 days of the referral.

Maximus assessor will meet the individual and complete an

initial assessment.

Maximus will facilitate with the individual’s physician to obtain a Physician’s

Certificate (within 30 days).

Once Physician’s Certificate is obtained, Maximus will make a request to the

AAA to have a LOCA completed to determine medical eligibility for waiver

services (within 30 days).

After LOCA is completed, Maximus will make a request to the local CAO

to determine financial eligibility (within 45 days).

Maximus will offer the individual a choice of a service coordination agency

to facilitate services (offered at Maximus’ initial visit).

Upon state approval (Office of Long-Term Living), the support coordinator

will meet with the individual and offer choices of direct care providers as well

as assist in facilitating any additional support services the individual needs.

If I don't qualify for waivers, what other source of funding is available?

You may use informal supports from friends and families, state plan services
& third party liability such as insurance, medicare, workers comp, veteran’s
benefit and other state & federal programs. Waiver is only a last resort funding
source, after you have accessed & exhausted all other sources.

Will I loose benefit if I change or switch providers & how long does it take to switch?

Absolutely Not. You will not loose benefit or service, it’s a simple process which begins by calling your service coordinator, it only takes minute to complete the switch.

I love my care giver. Can I keep Him/Her when i make a switch?

Yes! Be sure to inform your service coordinator, when you call for the switch.

Whats your intake process for Care givers?

They have to pass an extensive background check
They have to pass competency test, written & Practical
They have to complete and meet the requirements
of our internal reference process
They have to have passion for caring and willingness to learn
new skills to meet new clients need.
Must pass SAM, LEIE & Medicheck exclusion record

I want to select Caresify but my Social Coordinator provided me with list of waiver service provider in my area & Caresify isn’t on the list, what should I do?

The compass system is designed to randomize listing, if
the list provided to you isn’t showing Caresify or another agency of
your choice, simply tell the social coordinator your preferred