Pennsylvania’s OLTL Program: What It Is and How to Get Started

The Pennsylvania Office of Long-Term Living (OLTL) is part of the Pennsylvania Department of Human Services (DHS). OLTL oversees programs that provide long-term care services and support to older Pennsylvanians and adults with physical disabilities.

Two of those programs specifically support something called self-directed care: the OBRA Waiver and the Act 150 Program.

Self-directed care is a way of receiving home-based support that puts you in control.

In a traditional care model, an agency assigns a worker to come to your home. You may not have much say in who that person is or when they show up.

Self-directed care works differently. When you self-direct, you choose who provides your support. That person can be someone you already know, a family member, a close friend, or a trusted neighbor. You decide the schedule. You manage the relationship. Your care is built around your life, not the other way around.

Both the OBRA Waiver and the Act 150 Program are built on this model. That means both programs are designed specifically for people who want and are able to take an active role in managing their own care.

The OBRA Waiver is a Medicaid program that helps adults with severe developmental physical disabilities live in the community and stay as independent as possible.

To be eligible for the OBRA Waiver, you generally need to meet all of the following:

• You are a Pennsylvania resident between the ages of 18 and 59. If you are already enrolled in the waiver when you turn 60, you can continue receiving services. New applicants who are 60 or older will be directed to other programs.
• You have a severe developmental physical disability that requires a specific level of care called an Intermediate Care Facility for Other Related Conditions, or ICF/ORC, level of care. This means your disability manifested before age 22, is expected to continue indefinitely, and causes significant limitations in at least three of the following areas of daily life: self-care, communication, learning, mobility, self-direction, or the capacity for independent living.
• You meet the financial eligibility requirements, which are determined by your local County Assistance Office.

The Act 150 Program is a state-funded program, not a Medicaid waiver, that was created for Pennsylvanians with physical disabilities who need attendant care services but do not financially qualify for Medicaid.

To be eligible for Act 150, you generally need to meet all of the following:

• You are a Pennsylvania resident between the ages of 18 and 59.
• You have a physical disability that has been diagnosed by a doctor and is expected to last at least 12 continuous months, or that may result in death.
• You are able to hire, supervise, and if necessary dismiss your own care worker. You are also able to manage your own financial and legal affairs.
• You went through the Medicaid eligibility process and were found financially ineligible.

If you are approved for Act 150, you may be required to pay a small co-payment toward the cost of your services. That co-payment is based on your income and will never be more than the total cost of your services.

Both programs are centered on personal assistance, which means hands-on support with the everyday activities that help you live safely and comfortably at home. The specific services you receive are based on your individual needs and are laid out in a care plan developed with your Service Coordinator.

Your care plan is not set in stone. If your needs change, your plan can change with them.

A Service Coordinator is a professional who helps you navigate the program from beginning to end. They work with you to develop your care plan, make sure your services are authorized, and connect you with the resources you need. Your Service Coordinator is your main point of contact throughout your time in the program, so building a good working relationship with them matters.

When you self-direct your care, you become your care worker’s employer. That is empowering, but it also comes with real responsibilities. Someone needs to handle your worker’s payroll, withhold and file the right taxes, manage employment paperwork, and make sure your worker is being paid correctly and on time.

That is what a Financial Management Services provider, or FMS provider, does. They handle the administrative and financial side of your self-direction program so you can focus on your care. Working with an FMS provider is a required part of participating in either the OBRA Waiver or the Act 150 Program.

Your FMS provider will help you and your care worker get enrolled in the program, process payroll using your authorized budget, handle all employment-related taxes, and provide you with regular reports so you always have a clear picture of your spending and your remaining authorized hours.

Getting into one of these programs involves several steps, but you will have support at every stage.

Your first call is to Pennsylvania’s Independent Enrollment Broker, known as the IEB. The IEB is the organization that helps people apply for long-term services and supports through OLTL. Let them know you are interested in learning about the OBRA Waiver or the Act 150 Program.

After you call, the IEB will schedule a visit to your home. During that visit, they will begin a needs assessment, walk you through the programs available to you, explain your rights, and give you information about your options including self-direction. They will also help you choose a Service Coordination organization so you can get a Service Coordinator assigned to you.

The IEB will coordinate two things: a functional eligibility assessment that looks at your level of care needs, and a financial eligibility determination through your County Assistance Office. Your doctor will also need to complete a form called a Physician Certification. All of this needs to be completed before your application can move forward.

Once your eligibility is confirmed, the IEB will walk you through your service options. If you choose self-direction, your Service Coordinator will submit a referral to your FMS provider to begin the enrollment process.

Your FMS provider will reach out to start enrollment for both you and your chosen care worker. This includes completing the necessary paperwork and verifying that your worker is eligible to work and ready to be set up in the payroll system.

Before your care worker can begin providing services or receive payment, your FMS provider will confirm that everything is in order. Once you receive your Good to Go confirmation, services can begin.

If you think the OBRA Waiver or the Act 150 Program might be right for you, the first step is a single phone call to the Pennsylvania Independent Enrollment Broker at 1-877-550-4227. You can also visit the Pennsylvania Department of Human Services OLTL page to learn more about both programs directly from the state.

Once you are enrolled and ready to begin, Public Partnerships (PPL) serves as the Financial Management Services provider for both the OBRA Waiver and the Act 150 Program in Pennsylvania. PPL handles payroll, taxes, enrollment support, and provides easy-to-use tools to help you manage your program day to day.

PPL’s OLTL customer service team can be reached at 1-877-908-1750 or at cs-oltl@pplfirst.com. You can also visit the PA OLTL Program page on the PPL website for forms, documents, and additional resources.

Also on the PPL blog: Pennsylvania’s ODP Program: What It Is and How to Get Started 

The Pennsylvania Office of Long-Term Living (OLTL) is a division of the Pennsylvania Department of Human Services that administers Medicaid programs providing long-term care services and supports to older Pennsylvanians and adults with physical disabilities. OLTL oversees programs including the OBRA Waiver and the Act 150 Program, which allow eligible individuals to receive care in their own homes rather than in a facility setting.

In Pennsylvania, Long-Term Services and Supports (LTSS) refers to a broad range of services that help older adults and individuals with disabilities carry out daily activities and live as independently as possible in their homes and communities. LTSS in Pennsylvania is administered through the Office of Long-Term Living (OLTL) and includes programs such as the OBRA Waiver, the Act 150 Program, and Community HealthChoices.