Pennsylvania family guide

Pennsylvania Medicaid waivers for children: PH95, ODP waivers, and PUNS

In Pennsylvania, a child under 18 with a disability may be able to get full, free Medicaid through a category called Medicaid for Children with Special Needs (PH95), which counts the child's own income, not the parents'. For children with an intellectual disability, autism, or certain developmental disabilities, long-term help at home, such as respite and in-home support, can come through three Office of Developmental Programs waivers that you request through your county MH/ID office, and there is a waiting list, so start both today.

Last verified: September 2026 Sources: PA Department of Human Services and federal agencies

The short answer

  1. Apply for Medical Assistance now, even if your income is "too high." Ask about the Medicaid for Children with Special Needs (PH95) category. Apply on COMPASS or call 1-866-550-4355.
  2. If your child has an intellectual disability or autism, call your county MH/ID office this week and make an appointment to register. That call starts the path to the Consolidated, Community Living, and Person/Family Directed Support waivers.
  3. Ask to be put on the PUNS. That is the form counties use for the waiting list. It records the date you first asked for help and how urgent your need is.
  4. If your child is under 5 and you have any concern about development, call CONNECT at 1-800-692-7288 for an Early Intervention referral. DHS says Early Intervention is provided at no cost to families.
  5. Keep copies of everything. DHS lists an IEP, an IFSP, or an Early Intervention evaluation report among the documents it accepts to start PH95 coverage presumptively while the disability review is pending.

This guide is not legal or medical advice. The Pennsylvania Department of Human Services (DHS) and your county make every eligibility decision. Confirm details with them. You can reach the ODP customer service line at 1-888-565-9435.

Programs at a glance

The Pennsylvania programs families ask about most

There are two layers. Medical Assistance (Pennsylvania's name for Medicaid) is the health coverage. A waiver adds long-term supports on top of it. DHS explains that the name comes from the federal government "waiving" Medicaid rules for institutional care, so Pennsylvania can use the same money for supports closer to home.

Ask about this Health coverage

Medicaid for Children with Special Needs (PH95)

Who it is for
Pennsylvania children under 18 who are disabled under Social Security (SSA) standards. The disability can be physical, developmental, mental health, or intellectual. Parental income must be verified but is excluded. The child's own countable income must be at or below 100% of the federal poverty guidelines. The DHS eligibility handbook describes the category as being for children who do not receive Supplemental Security Income (SSI).
What it can help with
Full, free Medical Assistance. DHS lists emergency and physician services, mental health treatment, prescriptions, medical supplies and equipment, and rehabilitation services.
How you get on it
An application: online through COMPASS, by phone at 1-866-550-4355, at your County Assistance Office, or by mail. It is the "category of last resort," so the County Assistance Office checks the other Medicaid categories first.
Official page →
Ask about this Benefit inside Medicaid

EPSDT (Early and Periodic Screening, Diagnostic and Treatment)

Who it is for
Children under age 21 who are enrolled in Medicaid.
What it can help with
Comprehensive and preventive care. Federal rules require states to furnish coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions.
How you get on it
It comes with your child's Medicaid, so the first step is getting Medical Assistance.
Official page →
Ask about this Birth to age 5

Early Intervention (Infant/Toddler and Preschool)

Who it is for
Children from birth to age five with developmental delays and disabilities. For children under 3, state rules include a delay of 25% of the child's age in one or more developmental areas, test scores 1.5 standard deviations below the mean, or a diagnosis likely to cause a delay.
What it can help with
Coaching and services for physical, cognitive, communication, social or emotional, and adaptive development, at home, in child care, or other familiar places. No cost to families.
How you get on it
A referral: call CONNECT at 1-800-692-7288, email help@connectpa.net, or use the online referral form.
Official page →
Ask about this Birth to age 3

Infants, Toddlers, and Families (ITF) Waiver

Who it is for
Children from birth until their third birthday with at least a 50% delay in one developmental area or a 33% delay in two areas, who need Early Intervention and need an ICF/ORC level of care. DHS lists an income limit of 300% of the Federal Benefit Rate.
What it can help with
Special instruction only. That is the one service this waiver funds.
How you get on it
Start with an Early Intervention referral. DHS says to apply through your County Assistance Office.
Official page →
Ask about this ODP waiver

Person/Family Directed Support (P/FDS) Waiver

Who it is for
People of any age with an intellectual disability or autism. It also covers children under 9 with a developmental disability that has a high probability of leading to one of those diagnoses, and people under 22 with a developmental disability due to a medically complex condition. They must need an ICF level of care and be eligible for Medicaid.
What it can help with
In-home and community support, respite, assistive technology, behavioral support, family/caregiver training, accessibility adaptations, therapies, and more. DHS lists a limit of $47,000 per person per fiscal year (not counting supports coordination or supports broker), which can be exceeded by $15,000 for certain employment and benefits counseling services.
How you get on it
Register with your county MH/ID office. If funding is not available, you go on the waiting list through PUNS.
Official page →
Ask about this ODP waiver

Community Living Waiver

Who it is for
The same diagnosis, age, level-of-care, and Medicaid requirements as P/FDS.
What it can help with
A larger budget. DHS lists a limit of $97,000 per person per fiscal year (not counting supports coordination). The service list includes in-home and community support, respite, shift nursing, life sharing, supported living, therapies, and home accessibility adaptations.
How you get on it
Register with your county MH/ID office. If funding is not available, you go on the waiting list through PUNS.
Official page →
Ask about this ODP waiver

Consolidated Waiver

Who it is for
The same diagnosis, age, level-of-care, and Medicaid requirements as the other two ODP waivers.
What it can help with
Of the three ODP waivers, this is the one whose DHS service list includes residential habilitation (licensed and unlicensed). The list also includes life sharing, supported living, respite, in-home and community support, shift nursing, and therapies.
How you get on it
Register with your county MH/ID office. DHS notes that each waiver can serve a limited number of people, and priority goes to people with the most emergent needs.
Official page →

Waiver figures come from DHS waiver pages that list amendments effective January 1, 2026. Some older DHS pages still show earlier limits, so confirm the current figure with your supports coordinator. For help estimating costs, try our therapy and equipment cost explorer.

Interactive

Which program should I ask about?

This is a starting point, not a decision. DHS, your County Assistance Office, and your county MH/ID office decide who qualifies. Nothing you pick here is saved or sent anywhere.

Step by step

How to apply, step by step

You can work on several of these at the same time.

  1. Apply for Medical Assistance for your child

    Apply online through COMPASS, by phone, in person at your County Assistance Office (CAO), or by mail. If your household income is too high for other categories and your child is under 18, ask the CAO to review your child for Medicaid for Children with Special Needs (PH95).

    DHS says a child can be approved presumptively (covered while the disability review is pending) with an IEP, an IFSP, an Early Intervention or school-age evaluation report, or a mental health facility discharge report. The DHS handbook also lists a physician certification form (PA 1960).

    COMPASS1-866-550-4355Find your CAO

  2. Send the medical records the CAO asks for

    The DHS Medical Review Team checks whether your child meets SSA disability criteria. The CAO will mail a letter asking for records, due within 30 days of the mail date. If you need more time, call your CAO early. DHS says coverage can stay open while you cooperate.

  3. If your child is under 5, request an Early Intervention evaluation

    Call CONNECT or submit the online referral. For infants and toddlers, Pennsylvania rules require the county program to complete the evaluation and either hold an IFSP meeting or make a plan for further assessment and tracking within 45 days of the referral.

    CONNECT 1-800-692-7288help@connectpa.netOnline referral

  4. Register with your county MH/ID office (the Administrative Entity)

    DHS says to call and make an appointment to register. Bring records that show eligibility, such as medical, psychological, and school records. For intellectual disability services, ODP requires a diagnosis based on objective standardized testing, with the condition present before age 22. The county then decides whether your child is eligible.

    County MH/ID directoryODP 1-888-565-9435

  5. Choose a supports coordinator and ask for a waiver application

    If your child is found eligible, you get supports coordination. DHS says you should have a choice of available supports coordinators and be able to meet them first. Your coordinator should offer you the chance to apply for a waiver. If funding is not available, they should offer the PUNS form and put you on the waiting list.

  6. Check your PUNS, then keep it current

    DHS says your coordinator will mail you a copy of the PUNS with a letter within three weeks of the meeting. Check that it is accurate. Update it at least once a year and whenever your child's needs change. Medicaid must also be renewed at least every 12 months.

County MH/ID offices in western Pennsylvania

These numbers are from the DHS county office directory. For other counties, use the full DHS list. Our Medicaid waiver state finder covers other states.

CountyOffice (per DHS)Phone
AlleghenyDepartment of Human Services, Office of Developmental Supports412-253-1399
Armstrong and IndianaArmstrong-Indiana Behavioral and Developmental Health Program724-548-3451
BeaverBehavioral Health-Developmental Disabilities724-847-6225
BlairBlair County Department of Social Services & Mental Health814-693-3023
ButlerHuman Services Department724-284-5114
CambriaBehavioral Health/Intellectual Disabilities/Early Intervention814-534-2800
Cameron and ElkCameron-Elk Behavioral & Developmental Programs814-772-8016
ClarionClarion County Mental Health/Developmental Disabilities/Early Intervention814-226-4000 ext. 1338
Clearfield and JeffersonCommunity Connections of Clearfield-Jefferson Counties814-371-5100
CrawfordCrawford County Human Services Mental Health/Intellectual Disabilities814-724-8380
ErieOffice of Mental Health/Intellectual Disabilities814-451-6800 or 814-451-6860
FayetteFayette County Behavioral Health Administration724-430-1370
Forest and WarrenForest-Warren Human Services814-726-2100
GreeneHuman Services Department MH and I/DD Programs724-852-5276
LawrenceMental Health and Developmental Services724-658-2538
McKeanMcKean County Department of Human Services814-887-3350
MercerMercer County Behavioral Health Commission724-662-1550
Somerset and BedfordBedford-Somerset Developmental and Behavioral Health Services814-443-4891
VenangoVenango County Mental Health/Developmental Services/Early Intervention Services814-432-9100
WashingtonBehavioral Health and Developmental Services724-228-6832
WestmorelandBehavioral Health & Developmental Services724-830-3617

If a problem with your county isn't resolved, DHS lists the ODP Western Regional Office at 412-565-5144. In Allegheny County, DHS lists the County Assistance Office headquarters at 412-565-2146.

The waiting list, honestly

How PUNS actually works

PUNS (Prioritization of Urgency of Need for Services) is a planning tool, not a promise of services. Your supports coordinator fills it out with you in a face-to-face meeting, and you can bring a teacher, an advocate, or family.

The PUNS places each need in one of three categories.

EmergencyThe need is immediate or will happen within six months.
CriticalThe need is expected after six months but within two years.
PlanningThe need is more than two years away but less than five years away.

"the Waiting List is not like a bakery or deli line"Pennsylvania DHS, Meeting with Your Supports Coordinator

DHS says the two biggest factors in when you get services are the funding available in your county and how urgent your need is. Each county gets a yearly funding allocation from ODP. People already enrolled in waivers must have their needs met before new people are enrolled. People in the Emergency category get priority but may still have to wait. DHS does not publish a single wait time, and we won't guess at one.

If you disagree with your PUNS, the ODP manual (dated May 5, 2025) says to return the disagreement form to your supports coordinator within 10 calendar days of receiving the finalized PUNS. The county or Administrative Entity makes the final decision. A PUNS category cannot be appealed through the Bureau of Hearings and Appeals. DHS does say you can formally appeal if you are denied the chance to apply for a waiver.

Why sign up now, even if you're not sure

  • The PUNS asks for the "Date Person Went on Waiting List." DHS says that is the date you first asked the county for support, which may be earlier than the date the form is filled out.
  • DHS says you need a PUNS if you expect to need services within the next five years, so needs that are years away still count.
  • Counties and the state use PUNS data to build their yearly budgets.
  • While you wait, everyone who meets waiver eligibility gets supports coordination, and DHS says county programs have limited base funding for some services.
  • For Medical Assistance, DHS says retroactive coverage can currently be approved for up to three months before the application. Starting January 1, 2027, that window changes to two months for new applicants other than Medicaid expansion adults (ages 19 to 64), who get one month. For PH95, the DHS handbook says retroactive months are covered only when medical documentation confirms the disability existed in that period.

Suggested script

What to say when you call

These are suggested words, not an official form. Change them to fit your family.

Suggestion: county MH/ID call

Calling your county MH/ID office

"Hi, my name is ____. My child, ____, is ____ years old and has ____. I'd like to make an appointment to register for intellectual disability and autism services. I'd also like to learn about the Person/Family Directed Support, Community Living, and Consolidated waivers."

"If funding isn't available right now, please complete a PUNS for my child so our need is on record. Can you tell me what records to bring to the appointment?"

Write down the date and who you spoke with. If you get stuck, ask for the county's "PUNS Point Person," which DHS says every county has.

Suggestion: CAO call

"I'm applying for Medical Assistance for my child, who has a disability. If we're over income for other categories, please review my child for the Children with Special Needs category, PH95."

Documents to gather

Checkboxes are for your own use and are not saved. The list is drawn from DHS application guidance.

Questions families ask

FAQ

Our income is too high for Medicaid. Can our child still qualify in Pennsylvania?

Possibly. DHS says Medicaid for Children with Special Needs (PH95) gives full, free Medical Assistance to children under 18 with disabilities whose parents make too much money for other Medicaid categories. Parental income is verified but excluded, and the child's own countable income must be at or below 100% of the federal poverty guidelines. The child must meet SSA disability standards.

Source: DHS PH95 page

Is PH95 the same thing people call the Medicaid loophole?

The official DHS name is Medicaid for Children with Special Needs (PH95). The DHS page for this category does not call it a loophole. When you apply, use the official name so the County Assistance Office knows exactly which category you mean.

Source: DHS PH95 page

Do we have to drop our private insurance to get PH95?

DHS's eligibility handbook tells caseworkers to record other coverage, such as private health insurance, and to explain that Medical Assistance is the payer of last resort. That means your private plan is billed first. Ask your County Assistance Office how this works for your plan.

Source: DHS MA Eligibility Handbook 315.5

My child has cerebral palsy but no intellectual disability or autism. Do the ODP waivers apply?

It depends on the details. DHS lists three groups: people of any age with an intellectual disability or autism, children under 9 with a developmental disability that has a high probability of leading to one of those diagnoses, and people under 22 with a developmental disability due to a medically complex condition. Ask your county MH/ID office whether your child fits. PH95 and EPSDT do not require an intellectual disability.

Source: DHS Consolidated Waiver page

How long is the waiting list for a Pennsylvania waiver?

DHS does not publish one statewide wait time. It says the most important factors are the funding available in your county and the urgency of your need, and that people in the Emergency category get priority but may still have to wait. Keeping your PUNS accurate and up to date is the part you control.

Source: DHS Meeting with Your Supports Coordinator

Can I appeal my child's PUNS category?

You can use the PUNS disagreement form. ODP's manual says to return it to your supports coordinator within 10 calendar days of receiving the finalized PUNS, and the county or Administrative Entity makes the final decision. A PUNS status cannot be appealed through the Bureau of Hearings and Appeals. DHS says you can formally appeal if you are denied the opportunity to apply for a waiver.

Source: ODP PUNS Manual

What is the difference between Early Intervention and the ITF Waiver?

Early Intervention serves children from birth to age five with developmental delays and disabilities, at no cost to families. The Infants, Toddlers, and Families Waiver is a Medicaid waiver for children from birth until their third birthday, and special instruction is the only service it funds. For either one, you can start by contacting CONNECT at 1-800-692-7288. DHS says to apply for the ITF Waiver through your County Assistance Office.

Source: DHS ITF Waiver page

What happens to PH95 when my child turns 18?

DHS says the disability certification stands until the child turns 18, or until you report that the condition has changed or is no longer disabling. Benefits must be renewed at least every 12 months. Before your child turns 18, ask your County Assistance Office which Medical Assistance category fits an adult.

Source: DHS PH95 page

Keep going

All family resourcesGuides for every stage Medicaid waiver state finderPrograms outside Pennsylvania Therapy and equipment cost explorerPlan for what coverage may not pay Cerebral palsyCondition guide Autism spectrum disorderCondition guide Down syndromeCondition guide

Still waiting on coverage?

Teagan's Crown is based in western Pennsylvania and helps families with the equipment, therapy, and relief that waiting lists leave out.

Apply for help

Sources

Sources

Every fact on this page comes from these official pages.

  1. Pennsylvania DHS: Medicaid for Children with Special Needs (PH95), accessed September 2026
  2. Pennsylvania DHS: Medicaid for Children with Special Needs brochure (PA 1989), accessed September 2026
  3. Pennsylvania DHS: Medical Assistance Eligibility Handbook 315.1, General Policy, accessed September 2026
  4. Pennsylvania DHS: Medical Assistance Eligibility Handbook 315.5, Determining Eligibility, accessed September 2026
  5. Pennsylvania DHS: Apply for Medicaid Benefits, accessed September 2026
  6. Pennsylvania DHS: Medicaid Changes, accessed September 2026
  7. Pennsylvania DHS: County Assistance Offices (CAO), accessed September 2026
  8. Pennsylvania DHS: Waiver Information, accessed September 2026
  9. Pennsylvania DHS: Consolidated Waiver, accessed September 2026
  10. Pennsylvania DHS: Community Living Waiver, accessed September 2026
  11. Pennsylvania DHS: Person/Family Directed Support Waiver, accessed September 2026
  12. Pennsylvania DHS: P/FDS Waiver application, effective January 1, 2026 (PDF), accessed September 2026
  13. Pennsylvania DHS: Community Living Waiver application, effective January 1, 2026 (PDF), accessed September 2026
  14. Pennsylvania DHS: Apply for a Medicaid Consolidated Waiver, accessed September 2026
  15. Pennsylvania DHS: Request a Medicaid Community Living Waiver, accessed September 2026
  16. Pennsylvania DHS: Prioritization of Urgency of Need for Services (PUNS), accessed September 2026
  17. Pennsylvania ODP: PUNS Manual, dated May 5, 2025 (PDF), accessed September 2026
  18. Pennsylvania DHS: Meeting with Your Supports Coordinator, accessed September 2026
  19. Pennsylvania DHS: Eligibility and Contact Information, Intellectual Disabilities, accessed September 2026
  20. Pennsylvania DHS: County Mental Health/Intellectual Disabilities (MH/ID) Offices, accessed September 2026
  21. Pennsylvania DHS: Early Intervention Services, accessed September 2026
  22. Pennsylvania DHS: Make a Referral for Early Intervention Services, accessed September 2026
  23. Pennsylvania DHS: Apply for the Medicaid Infant, Toddlers, and Families Waiver, accessed September 2026
  24. Pennsylvania Code: 55 Pa. Code 4226.5, Definitions, accessed September 2026
  25. Pennsylvania Code: 55 Pa. Code 4226.22, Eligibility for early intervention services, accessed September 2026
  26. Pennsylvania Code: 55 Pa. Code 4226.24, Comprehensive child find system, accessed September 2026
  27. Medicaid.gov: Early and Periodic Screening, Diagnostic, and Treatment, accessed September 2026
  28. eCFR: 20 CFR 416.906, Basic definition of disability for children, accessed September 2026

Teagan's Crown is not a government agency, and this page is not legal or medical advice. Programs and rules change. Confirm every detail with the Pennsylvania Department of Human Services: ODP customer service at 1-888-565-9435 (hearing-impaired only: 1-866-388-1114), the Consumer Service Center for Health Care Coverage at 1-866-550-4355, or your county MH/ID office.

Where your gift goes

You choose. A child grows.

Pick exactly what your gift supports. Every dollar goes to work for children with special needs and the families who fight for them.

Family in the fight? Apply for help →For children 21 and under. We help the greatest need first.

Tools that help

Browse every guide in the resource library, or apply for family support.

Link copied