PHLP provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call our helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail us at staff@phlp.org.

Health Care Services

Individuals with a diagnosis of mental retardation can get health care services in Pennsylvania from several sources. Many individuals can qualify for Medical Assistance, even if they work. Medical Assistance provides comprehensive health care including physician services, inpatient and outpatient care, PT, OT, ST, prescription drugs, durable medical equipment, dental care, and more to eligible persons with mental retardation.

For more information on Medical Assistance, see our section on Medical Assistance. If the person is a child, see our Loophole Guide for information on how he or she might qualify for Medical Assistance even if his/her family exceeds the income limits. See our Quickscreen Eligibility Tool to see if you might qualify.

Supportive Services

Supportive services are an array of services that support a person with mental retardation so that they can live in their community . These services may include respite care, vocational training, habilitation services, and transportation. Supportive services for people in the mental retardation system are most commonly provided either through special Medical Assistance-funded programs known as “waivers” or by programs funded through County MH/MRs, know as “base funded programs”. The most common base funded program for home and community based supports is Family Support Services (“FSS”), also known in some counties as Family Driven Support Services (“FDSS”).

In order to obtain services and supports through the mental retardation system, the individual must meet the definition of mental retardation which includes an IQ (by test or clinical judgment) below 70 plus significant limitations in adaptive functioning in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. The onset must occur before the individual's 22nd birthday.

There are three home and community based services waiver programs that provide home and community based services to persons with mental retardation. These are:

1. Infants/Toddlers Waiver- Early Intervention services for children ages birth to 3. This waiver is not limited to children with mental retardation but is rather based on developmental delay. Children who meet the developmental delay criteria for Early Intervention are entitled to services regardless of whether they apply for this waiver.
2. Person/Family Directed Support (PFDS) Waiver for children and adults age 3 or older who meet the mental retardation criteria. This waiver provides up to $22,525 annually for services. Persons needing services costing above that amount can be placed on the county's waiting list for the Consolidated Waiver and may receive some FSS or FDSS funds (see below) while they are on the waiting list. Services include:
• Community based habilitation- in home and licensed day programs
• Pre-vocational, transitional work & Supportive Employment,
• Environmental Adaptations (home modifications),
• Transportation,
• Homemaker/Chore Services,
• Adaptive Appliances,
• Respite Care,
• Visiting Nurses and Therapies
• Behavior therapy
3. Consolidated Waiver (is limited to individuals with mental retardation aged 3 and over who would otherwise require the care of an intermediate care facility for persons with mental retardation). It has no upper funding limit. Funding is based upon a person's Needs assessment and a Plan of Care). Children are not usually put into the Consolidated Waiver unless they are being placed out of home although families can request the Consolidated Waiver for a child at home who has very significant needs and could be maintained at home with services costing above the cap for the PFDS waiver. The Consolidated waiver covers all the services covered under PFDS plus the following additional services :
   • Residential Habilitation (group home)
   • Family living homes (life sharing)
   • Education support
   • Home Finding Services

There are significant waiting lists for the PFDS and especially for the Consolidated waiver slots. Priority for open slots is given to those with the most urgent needs as determined using the “PUNS” form. Persons who are on the waiting list for the PFDS or Consolidated Waivers may be able to obtain some services from their county MH/MR through “FSS” or “FDSS” funds. While there are no state-imposed caps on the cost of services that can be funded under FSS or FDSS, counties usually provide funding of less than $1000 a year per eligible person. Services funded under FSS/FDSS include respite, minor home modifications, family aide and recreational activities.

For more information or general questions, you may call the Office of Developmental Programs at: 1-800-565-9435

To apply for supportive services available through the MR waivers, county MH/MR or in one of the three HCBS Waiver programs for persons with MR, contact your local MH/MR.

Education Services for Persons with Mental Retardation

If you are a parent or guardian and are having trouble getting your child services in school, you should consult the Education Law Center at 215-238-6970 and 412-391-5225, the Parents Education Network at 800-522-5827 and the PEAL Center serving Western and Central Pennsylvania at 1-866-950-1040 and 412-281-4404.