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Comparison of Medicaid Programs that Serve Adults with Autism Spectrum Disorders (ASD)

Adult Autism WaiverAdult Community Autism

Program (ACAP)Consolidated and PFDS

WaiversOBRA Waiver

Eligibility Diagnosis

Autism Spectrum Disorder(ASD)

1

Autism Spectrum Disorder (ASD)1 Intellectual disability (alsoknown as mentalretardation)

Eligibility Levelof Care

Either Intermediate CareFacility for people with OtherRelated Conditions (ICF/ORC)or Intermediate Care Facilityfor people with Mental

Retardation (ICF/MR), IQscore is not considered.

Either Intermediate Care Facility forpeople with Other RelatedConditions (ICF/ORC) orIntermediate Care Facility forpeople with Mental Retardation

(ICF/MR),IQ score is notconsidered.

ICF/MR

Eligibility Financial

Medical Assistance FinancialEligibility requirements for

long-term care participants

Medical Assistance FinancialEligibility as determined by the

County Assistance Office (CAO)(Long Term Care requirements donot apply)

Medical AssistanceFinancial Eligibility

requirements for long-term care participants

Eligibility Age 21 and older 21 and older 3 and older

Geographic Area Statewide Cumberland, Dauphin, Lancasterand Chester counties

Statewide

The OBRA Waiver is currentlyclosed.

For questions about individualswho are currently receivingservices through the OBRAwaiver, please contact SharonTomforde at (717) 783-8391 orstomforde@state.pa.us

If providers have questionsabout the waiting list and theimpact that may have onindividuals, please sendquestions to the following emailaccount with the words OBRAWaiver Waiting List in thesubject line:

ra-act150review@state.pa.us

Type of Program 1915(c) Medicaid Home andCommunity-Based ServicesWaiver

ACAP is a Home and Community-Based Services program thatprovides physician, behavioral, andcommunity services through anintegrated approach to create acoordinated system of supports

1915(c) Medicaid Homeand Community-BasedServices Waivers

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mailto:stomforde@state.pa.usmailto:ra-act150review@state.pa.usmailto:ra-act150review@state.pa.usmailto:stomforde@state.pa.us

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services Respiratory services Targeted Case Management Assistive Technology Behavioral Support (similar to

Behavioral Specialist Services inwaiver)

Community Transition Services Crisis Intervention Services Adult Day Habilitation Environmental Modifications Family Counseling Habilitation Homemaker/Chore services Non-Medical Transportation Personal Assistance Services Pre-vocational Services Residential Support (similar to

Residential Habilitation) Respite Supported Employment Supports Coordination Visiting Nurse Additional services determined

necessary Physical, Occupational, vision

and mobility, and speechtherapies (group and individual)

Certified nurse Practitioner Podiatrist

There is no individual cost limit, or

cap. However, all services mustbe determined medically necessaryand listed in the ISP.

Therapies (Behavior,Occupational, Physical,Speech,Visual/Mobility)

Transitional Work

Services Transportation

The PFDS Waiverincludes an individualcost limit, or cap. Allservices funded throughthe PFDS Waiver, withthe exception of Supports

Coordination, may notexceed this limit for anyparticipant during a fiscalyear. The individual costlimit is currently $26,000per participant per fiscalyear. There are alsoservice limitations forsome specific waiverservices.