Frequently Asked Questions: Eligibility
Who is eligible for the Adult Autism Waiver?
In order to be eligible for the Adult Autism Waiver, a person must be age 21 or older, a resident of Pennsylvania (or planning to be a resident at the time of enrollment) and meet certain diagnostic, financial and functional eligibility criteria listed below. Priority is given to people not already receiving ongoing state-funded or state and federally-funded long-term care services.
- Must have a diagnosis of an Autism Spectrum Disorder (ASD), which includes:
- Autistic Disorder
- Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)
- Asperger Syndrome
- Childhood Disintegrative Disorder
- Retts Disorder
Must meet Medicaid Medical Assistance resource and income limits for waiver programs in Pennsylvania
Must have substantial functional limitations that are likely to continue indefinitely in three or more of the major life activities listed below. These functional limitations, which must be evident before the person reaches the age of 22, include limitations in:
- understanding and use of receptive and expressive language
- capacity for independent living
Can someone with a diagnosis of an intellectual disability (also called mental retardation) enroll in the Adult Autism Waiver?
Yes, as long as they meet all the eligibility criteria listed above.
If I am already receiving services, can I still apply for the Adult Autism Waiver?
Yes. A person can request an application while receiving services from another waiver program, but once a person is enrolled in the waiver they will have to disenroll from the other waiver program. However, timelines are coordinated so that you will continue to receive services from the old programs until the new one starts.
The Adult Autism Waiver is designed, however, to give preference to people who do not now get any state-funded or state and federally-funded ongoing services. Applicants are grouped in a criteria category:
Priority 1: Those not already receiving state-funded or state and federally-funded home and community-based services.
Priority 2: Those currently enrolled in state-funded or state and federally-funded home and community-based services.
Another way to look at this difference is described below:
- People who are now enrolled in a home and community-based services waiver (such as OBRA, Consolidated or P/FDS) or live in a state MR center, an Intermediate Care Facility, a state mental hospital or a nursing home are in Priority 2.
- Everyone else is in Priority 1.
Everyone who is placed into a priority category will receive a status letter to confirm that category. BAS maintains separate lists of people requesting an application based on their Priority status. No applications will be sent out to people on the Priority 2 list until everyone on the Priority 1 list has had their application processed. This means that it may be a while before people who are already on a waiver receive an application for the Adult Autism Waiver.
If I only get Base Service Unit funds for people with intellectual disabilities, am I considered in the Priority 2 category?
Base Service Unit (BSU) funding is not guaranteed from year to year, so it is not considered ongoing funding. A person only receiving BSU funding would be classified as Priority 1.
If eligibility starts at age 21, how far in advance should I apply for the Adult Autism Waiver, so that services can be in place when I turn 21?
Individuals can request an application at any time. However, applications will be denied if they are received prior to 90 days before the applicant’s 21st birthday.
If I am found eligible for the Adult Autism Waiver how long can I remain in the program?
There is no time limit or maximum age limit. Participants are assessed each year to ensure they continue to meet all eligibility requirements.
For more information about the Adult Autism Waiver, including the General Overview, Application Process, Services, or Providers please see the additional program handouts or visit www.autisminpa.org
Frequently Asked Questions: Application Process
How do I request an application?
All application requests must be made through the Bureau of Autism Services’ toll free number at 1-866-539-7689. Applications may not be requested by email and are not available on-line. Call the toll free number and leave a message with the following information:
- Name of person who wishes to apply
- Telephone number
- County of residence
If you are calling on the behalf of the person who wishes to apply also leave your name and daytime phone number.
What happens after I request an application? What are the steps and the timeline in the application process?
It is important to note that some steps in the application process will happen in specific timeframes and others depend on external factors. For example, how soon an application is sent out after a request is made depends on program capacity. Specific timeframes have been included on the chart wherever possible. If an applicant has specific questions about his/her stage of the application process, please contact the Adult Autism Waiver staff directly by emailing or calling 1-866-539-7689.
A functional assessment is part of the eligibility process for the Adult Autism Waiver. Who completes the functional assessment and where?
This assessment is completed in-person by trained staff contracting with Bureau Autism Services. The location is determined jointly with the applicant. Generally, the individual’s home is preferred.
What will the Adult Autism Waiver application packet include? What paperwork will I need to fill out?
The waiver application packet includes a three-page application; if the applicant is not already receiving Medical Assistance (MA), an application for that will also be included. The applicant only needs to complete the application and provide proof of age, such as a copy of a driver’s license, state identification card, or birth certificate. Bureau of Autism Services staff are available to answer questions and help applicants with the form.
How do I decide whether to apply for a waiver for people with intellectual disabilities, the Adult Community Autism Program or the Adult Autism Waiver?
For an overview of Pennsylvania programs for adults with developmental disabilities, please reference the Comparison of Medicaid Programs that Serve Adults with Autism Spectrum Disorder (ASD). This chart, available at www.autisminpa.org, compares the Adult Autism Waiver and the ACAP program with other Pennsylvania programs where adults with ASD may be eligible. For a more specific side-by-side look at the Adult Autism Waiver and the ACAP program, please review the Adult Autism Waiver/ACAP Program Comparison Chart, also available on www.autisminpa.org. These charts can also be found at http://bastraining.tiu11.org or you may call BAS at 1-866-539-7689 and BAS will mail the charts to you.
A recorded presentation providing additional information about the application process is available by visiting http://bastraining.acrobat.com/p63628323.
Topic: What You Need to Know About the Assessment Process for BAS Adult Services
This session is for adults or their families interested in the Adult Autism Waiver or Adult Community Autism Program (ACAP) enrollment processes. During the session, discussion topics included Functional Eligibility determination for the programs as well as the other assessments done by supports coordinators. These assessments are used to assist in determining participants’ needs. A short explanation of some of the more specialized services was also covered, such as job finding/assessment/support and behavior specialist supports.
For more information about the Adult Autism Waiver, including the General Overview, Eligibility, Services, or Providers please see the additional program handouts or visit www.autisminpa.org
Bureau of Autism Services
PO Box 2675
Harrisburg, Pennsylvania 17120