Frequently Asked Questions: State Benefits & Medicaid Waivers

What is the difference between Medicaid and a Medicaid waiver? Medicaid is a health insurance program. A Medicaid waiver is a separate federal authorization that allows states to use Medicaid funds to pay for home and community-based supports — such as personal care, day programs, and supported employment — that are not covered under standard Medicaid. Qualifying for Medicaid does not automatically mean a person is enrolled in a waiver program.

How long is the wait for a Medicaid waiver in Pennsylvania? Wait times vary significantly depending on the waiver type and the individual’s priority status. Some individuals wait several years. Establishing waiting list placement early — even before services are urgently needed — is strongly recommended. Leahy Life Plan can help families understand how to initiate this process.

Can my family member lose their waiver if they start working? Not necessarily — but employment can affect Medicaid eligibility, which is the funding source for waiver services. Planning before employment begins is essential. Pennsylvania offers the Medical Assistance for Workers with Disabilities (MAWD) program, other states offer similar programs known as the Medicaid Buy In. which may allow employed individuals to maintain Medicaid coverage through a premium payment structure. Leahy Life Plan can help evaluate the specific impact of employment on an individual’s benefits package.

What is an ISP and who is involved in developing it? An Individualized Support Plan (ISP) is a planning document developed collaboratively between the individual with a disability, their family or designated supports, their Support Coordinator, and relevant service providers. It outlines goals, services, and support strategies. Families have the right to advocate for specific services and to request changes to a plan that does not adequately reflect the individual’s needs.

Does Leahy Life Plan provide legal or medical advice? No. Leahy Life Plan provides education, planning guidance, and advocacy preparation. For legal matters — including guardianship, estate planning, and Special Needs Trusts — clients are referred to qualified special needs attorneys. For medical documentation needs, clients work directly with their treating providers.

Do you work with clients outside of Pennsylvania? Yes. While state benefits vary significantly from state to state, Leahy Life Plan works with clients throughout the greater New York City metro area, across the Mid-Atlantic region, and nationwide via remote consultation. State-specific guidance is always provided in the context of the individual’s home state programs.

Ready to Navigate State Benefits and Medicaid Waivers?

State disability benefits are among the most powerful — and most difficult to access — supports available to individuals with disabilities and their families. The earlier planning begins, the more options remain available.

Whether you are just beginning to explore waiver eligibility, preparing for an ISP meeting, or navigating a housing or employment transition, Leahy Life Plan is here to help you understand your options and advocate effectively within the system.

• State Disability Benefits & Medicaid Waivers
• Understanding Medicaid Waivers
• Medicaid Waiver Eligibility
• Navigating the Waiver Application Process
• Medicaid Spend-Down Strategies
• Individualized Support Plan (ISP) Advocacy
• Person-Centered Planning Integration
• Disability Housing Options
• Employment While Utilizing Medicaid Waivers

Serving clients in Pennsylvania, the greater Philadelphia area, the New York City metro area, New Jersey, and nationwide via remote consultation.