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

The Pennsylvania Office of Developmental Programs, most people call it ODP, is part of the Pennsylvania Department of Human Services. ODP oversees intellectual disability and autism services across the state, including a set of Medicaid waiver programs that fund home and community-based support for eligible individuals.

ODP does not work alone. Services are administered in partnership with county offices across Pennsylvania, which play an important role in the eligibility and enrollment process. More on that in a moment.

Normally, Medicaid rules are set up to pay for care in institutional settings, like nursing facilities or intermediate care facilities. A waiver means the federal government has agreed to set aside that requirement so the state can use the same Medicaid funding to support people in their own homes and communities instead.

This matters because many people who qualify for ODP services would otherwise need a significant level of institutional care. A waiver is what makes it possible for those same people to receive the support they need while continuing to live at home, stay connected to their communities, and maintain as much independence as possible. All three ODP waiver programs are built on that principle.

ODP administers three Medicaid waiver programs that support self-directed care for individuals with intellectual disabilities, autism, and developmental disabilities. All three are built around the same goal: helping people live full lives in their homes and communities. They differ in the level of services they cover and how individual budgets are structured.

The PFDS Waiver is designed for individuals who need an intermediate level of care. It comes with an individual budget cap of $47,000 per person per fiscal year. Supports Coordination and Supports Broker services are not counted toward this limit. This cap can be exceeded by up to $15,000 for certain employment-related services.

The Community Living Waiver supports individuals of any age with an intellectual disability or autism, as well as certain children and young adults with developmental disabilities. It has an individual budget cap of $97,000 per person per fiscal year. Supports Coordination is not counted toward this limit.

The Consolidated Waiver covers the same population as the other two waivers but is designed for individuals with more intensive support needs. Unlike the PFDS and Community Living Waivers, the Consolidated Waiver does not have a specified individual cost limit.

Your Supports Coordinator, once assigned, will work with you to determine which waiver is the right fit based on your needs and goals.

All three waivers serve the same population. To be eligible, an individual generally must meet the following:

• Have an intellectual disability or autism. Children under age 9 with a developmental disability that has a high probability of resulting in an intellectual disability or autism diagnosis may also be eligible. Individuals under age 22 with a developmental disability due to a medically complex condition may also qualify.
• Be recommended for an intermediate care facility level of care based on a medical evaluation.
• Meet the financial eligibility requirements for Medicaid in Pennsylvania, as determined by your local County Assistance Office.

Eligibility for intellectual disability services specifically requires a diagnosis based on objective standardized testing. An intellectual disability is a permanent condition that affects a person’s ability to learn and function in daily life, and it must have occurred during the developmental period, meaning before the person’s 22nd birthday.

One important thing to know: all three ODP waivers have waiting lists. Priority for enrollment is given to individuals with the most urgent needs. Registering with your county office as early as possible is important, and we will walk through how to do that below.

Once enrolled, participants work with their Supports Coordinator to develop an Individual Support Plan, or ISP. This plan is built around the person’s specific needs, goals, and vision for their life. It outlines the services and supports they will receive and can be updated as circumstances change.

Services available through the ODP waivers are broad and designed to support everyday life. Depending on which waiver you are enrolled in, services can include:

• Personal assistance and in-home support
• Residential supports and community living
• Employment services
• Community participation support
• Behavioral support
• Therapy, including physical, occupational, and speech
• Assistive technology and home accessibility adaptations
• Respite for family caregivers
• Transportation, including mileage reimbursement and public transit options
• Approved goods and services purchased through your allocated budget

The specific services available to you will depend on which waiver you are enrolled in and what is included in your Individual Support Plan.

Within the ODP waiver programs, self-direction, also referred to as Participant Direction Services or PDS, is an option, not a requirement. It is available to participants enrolled in the Consolidated Waiver or the PFDS Waiver who live in their own home or in the home of a family member or friend.

If you choose self-direction, you or a surrogate, such as a family member acting on your behalf, take on the role of employer for the person who supports you. That person is called a Support Service Professional, or SSP.

Self-direction means you choose who provides your support, when they work, and how your care is organized. Your SSP can be someone you already know and trust. You manage that relationship directly, with support from your Supports Coordinator and your Financial Management Services provider.

If you are enrolled in the Consolidated Waiver or the PFDS Waiver and want to explore self-direction, reach out to your Supports Coordinator and ask them to submit a referral.

A Supports Coordinator is a professional who helps you navigate the ODP system from beginning to end. They work with you to develop your Individual Support Plan, connect you with services and providers, and make sure everything is in place for your support to run smoothly. Every person who qualifies for ODP services receives a Supports Coordinator. You have the right to choose your own, and you should have the opportunity to meet with them before making that decision.

When you choose to self-direct your care, you become your Support Service Professional’s employer. That means someone needs to handle payroll, withhold and file employment taxes, manage paperwork, and make sure your SSP is paid correctly and on time.

That is what a Financial Management Services provider, or FMS provider, does. They take on the administrative and financial side of your self-direction program so you can focus on your care and your life. Working with an FMS provider is a required part of self-directing your services under ODP.

In Pennsylvania’s ODP program, there are two types of FMS:

• Agency with Choice (AWC): a model provided by provider agencies enrolled with ODP, in which the agency serves as the employer of record for your SSP while you retain choice and direction over your care.
• Vendor Fiscal/Employer Agent (VF/EA): a model in which you or your surrogate serves as the Common Law Employer, taking on a greater level of control and responsibility for managing your SSP.

Your Supports Coordinator can walk you through the differences and help you decide which model is the right fit for you.

Your FMS provider will help you and your SSP get enrolled, process payroll using your authorized budget, handle all employment-related taxes, process payments for approved goods and services, and provide you with regular reports so you always know where your budget stands.

Getting into the ODP system involves several steps. Here is how the process typically works.

The first step is to contact your local County Office of Mental Health and Intellectual Disabilities (MH/ID office). This is where the eligibility process begins. If you are not yet registered with your county office, call them and make an appointment. Bring documents that help establish eligibility, such as medical records, psychological assessments, and school records.

At your appointment, the county office will review your records and determine whether you are eligible for intellectual disability services through ODP. They may schedule additional assessments as part of this process.

If you are found eligible, you will receive Supports Coordination. You have the right to choose your Supports Coordinator from a list of available providers. Your Supports Coordinator will then work with you to develop your Individual Support Plan and guide you through the next steps, including applying for a Medicaid waiver if appropriate.

Your Supports Coordinator will assist you in applying for the waiver that best fits your needs. Keep in mind that all three ODP waivers have waiting lists. Registering early and working closely with your Supports Coordinator gives you the best chance of moving forward as capacity becomes available. Priority is given to individuals with the most urgent needs.

If you are enrolled in the Consolidated Waiver or the PFDS Waiver, self-direction is available to you as an option if you live in your own home or in the home of a family member or friend. If you want to direct your own services and hire your own Support Service Professional, let your Supports Coordinator know. They will submit a referral to an FMS provider to get that process started.

Your FMS provider will reach out to complete enrollment for both you and your SSP. Once all required paperwork is in order and your SSP is set up in the payroll system, you will receive a Good to Go confirmation. Services cannot begin and your SSP cannot be paid until that confirmation is in place.

If you think ODP services might be right for you or your loved one, the place to start is your local County Office of Mental Health and Intellectual Disabilities.

Once you are enrolled and ready to take the next step, Public Partnerships (PPL) serves as the statewide Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services provider for the ODP program in Pennsylvania.

PPL handles payroll, taxes, enrollment support, and provides tools to help you manage your program day to day. PPL’s ODP customer service team can be reached Monday through Saturday at 1-800-249-0861 or at PAODP-CS@pplfirst.com.

You can also visit the PA ODP Program page on the PPL website for guides, forms, and additional resources.

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

The Pennsylvania Office of Developmental Programs (ODP) is a division of the Pennsylvania Department of Human Services that oversees services and supports for individuals with intellectual disabilities, autism, and developmental disabilities. ODP administers Medicaid waiver programs that fund home and community-based services designed to help eligible individuals live independently in their homes and communities.

ODP administers Medicaid waiver programs, including the Consolidated Waiver, the Community Living Waiver, and the Person/Family Directed Support (PFDS) Waiver, which fund services and supports for Pennsylvanians with intellectual disabilities, autism, and developmental disabilities. The office works in partnership with county Mental Health and Intellectual Disabilities (MH/ID) offices across Pennsylvania to determine eligibility and coordinate services for individuals and their families.

To be eligible for an ODP Medicaid waiver in Pennsylvania, an individual must have a diagnosis of an intellectual disability, autism, or a qualifying developmental disability, be recommended for an intermediate care facility level of care based on a medical evaluation, and meet Medicaid financial eligibility requirements. Eligibility is determined through the local County Office of Mental Health and Intellectual Disabilities (MH/ID).

The ODP program is Pennsylvania’s system of Medicaid-funded services and supports for individuals with intellectual disabilities, autism, and developmental disabilities, administered by the Office of Developmental Programs within the Pennsylvania Department of Human Services. It provides home and community-based services through three Medicaid waivers that allow eligible individuals to live independently, participate in their communities, and direct their own care.