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PRIOR PRINTER'S NO. 1045 PRINTER'S NO. 3294
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE RESOLUTION
No. 134
Session of
2025
INTRODUCED BY CERRATO, M. BROWN, HOHENSTEIN, D. MILLER, KHAN,
SANCHEZ, HILL-EVANS, WAXMAN, GUENST, HARKINS, GIRAL, PROBST,
McNEILL, MADDEN, OTTEN, HOWARD, HANBIDGE, DEASY, KAZEEM,
CEPEDA-FREYTIZ, RIVERA, D. WILLIAMS, STEELE, DALEY, GREEN,
FLICK, O'MARA AND CIRESI, MARCH 19, 2025
AS REPORTED FROM COMMITTEE ON HUMAN SERVICES, HOUSE OF
REPRESENTATIVES, AS AMENDED, APRIL 28, 2026
A RESOLUTION
Directing the Joint State Government Commission to conduct a
study and issue a report on the programs administered by the
Office of Long-Term Living and the Office of Developmental
Programs focused on how to improve the experience of
individuals with disabilities that receive a Home and
Community-Based Services waiver.
WHEREAS, More than 2 million Pennsylvanians have a
disability, or approximately one-fourth of Pennsylvanians, which
includes mobility and cognitive disabilities; and
WHEREAS, Adults with disabilities are more likely to
experience other health issues, such as obesity, diabetes and
heart disease, than the average adult and they face barriers to
independent living and employment; and
WHEREAS, Home and Community-Based Services waivers offer
resources through a variety of Medical Assistance waivers which
support the particular needs of residents of this Commonwealth
in community settings, enabling recipients to live in their
communities rather than seeking care in an institutional
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setting, such as an intermediate care facility for individuals
with intellectual disabilities, an intermediate care facility
for individuals with other related conditions or a nursing
facility; and
WHEREAS, Home and Community-Based Services waivers were first
created by an act of Congress in 1981 that amended the Social
Security Act to address a bias in the structure of Medicaid
towards providing benefits in institutional settings; and
WHEREAS, Congress created the waiver program to allow states
to apply for waivers that enable the state to target services to
areas of need and particular populations, especially to help
recipients remain in their community, rather than residing in an
institution; and
WHEREAS, Home and Community-Based Services waivers are
required to be cost-neutral and, by providing care equivalent to
Medicaid care in the community, costs are often lower than under
standard Medicaid; and
WHEREAS, There are multiple waivers available for home and
community-based services in this Commonwealth that vary in their
target population and the benefits provided, with waivers
available for residents with conditions, including autism and
developmental physical disabilities, and older Pennsylvanians;
and
WHEREAS, Home and Community-Based Services waivers are
administered by the Department of Human Services, and some of
the programs, like the Community HealthChoices Waiver and the
OBRA Waiver, are administered by the Office of Long-Term Living
(OLTL), and other programs, like the Community Living Waiver and
the Adult Autism Waiver, are administered by the Office of
Developmental Programs (ODP); and
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WHEREAS, Home and Community-Based Services waivers give the
Commonwealth the flexibility to offer care that is not typically
available under Medicaid so that vulnerable individuals can
continue to live in the community rather than an institution;
and
WHEREAS, In 1978, the Congress of the United States defined
developmental disability as a severe, chronic disability due to
a physical or mental impairment, manifesting before 22 years of
age, likely to continue indefinitely, and resulting in
substantial functional limitations in three or more major life
activities; and
WHEREAS, This definition was updated in 2000 by the
Developmental Disabilities and Bill of Rights Act of 2000,
emphasizing the need for lifelong, individualized support; and
WHEREAS, Pennsylvania has adopted eligibility criteria for
Home and Community-Based Services waivers that exclude some
individuals who meet the Federal definition of developmental
disability, thus preventing them from receiving the necessary
services; and
WHEREAS, Inadequate service availability and provision can
detrimentally affect an individual's health, ability to live
independently, work and have self-determined lives; and
WHEREAS, Data submitted by the Department of Human Services
to the Employment First Oversight Commission shows that in 2023,
18% of ODP's Home and Community-Based Services waiver
participants 18 to 64 years of age are employed in an integrated
setting and earning a minimum wage or higher; and
WHEREAS, Supporting access to Home and Community-Based
Services waivers, medical assistance and other public assistance
is important to the Commonwealth's commitment to health equality
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and equal participation in our communities; and
WHEREAS, The concerns and needs of the individuals who use
these programs should be the foremost priority for legislators
in delivering assistance to those individuals; therefore be it
RESOLVED, That the House of Representatives direct the Joint
State Government Commission to conduct a study and issue a
report on the programs administered by the Office of Long-Term
Living and the Office of Developmental Programs focused on how
to improve the experience of individuals with disabilities that
receive a Home and Community-Based Services waiver; and be it
further
RESOLVED, That the study:
(1) Report on whether Home and Community-Based Services
waivers meet the medical needs of recipients who have a
disability, and ways in which care under waivers can be
improved to better meet the medical needs of individuals with
disabilities, taking into consideration those differences in
the needs of individuals with physical disabilities,
intellectual disabilities, autism and other developmental
disabilities.
(2) Report on access to primary, secondary and tertiary
prevention health care, medical supplies, nursing services,
medically related supports such as tube feedings or catheter
changing, and the social determinants of health for
individuals with disabilities on Home and Community-Based
Services waivers and whether the access adequately meets the
needs of individuals with disabilities.
(3) Report on the barriers and facilitators to hiring an
attendant or direct care worker to be able to provide these
supports when a nurse is not available under these waivers.
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(4) Examine challenges faced by waiver participants to
avoid institutionalization and to be supported to remain
actively engaged in their community.
(5) Report on cases where health or administrative
challenges with waivers lead an individual with a disability
to seek care in an institution instead of remaining in the
community.
(6) Examine and compare the service menus in the OLTL
versus those in ODP, recognizing that the needs of
individuals in both programs may be the same or similar, to
include enhanced payments for in-home supports and
communication supports, supports brokers, two-to-one staffing
ratios, housing transition and tenancy sustaining services,
communication specialist, family caregiver training and
support, family medical support assistance, Agency With
Choice and supports provided during hospitalization.
(7) Examine the root causes of the percentages of OLTL
participants in competitive integrated employment being one-
thirteenth of those served by ODP's waivers.
(8) Compare participant-directed worker wage ranges, the
ability to offer nonmandatory, benefits, training
requirements and enhanced payments for direct care workers in
OLTL's OBRA waiver and the Attendant Care Services Act to
those for support service workers in the ODP's waivers.
(9) Report on ways in which Home and Community-Based
Services waivers administrative processes and eligibility
criteria could be improved to address the challenges facing
individuals with disabilities eight years of age and older to
access Home and Community-Based Services waivers.
(10) Evaluate ways in which other states have
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accommodated the diverse needs of individuals with
disabilities and altered their public assistance programs as
a result, including the utilization of the Federal definition
of "developmental disabilities."
(11) Report on barriers and facilitators to accessing
direct care services for individuals with disabilities on
Home and Community-Based Services waivers, including the
differing standards for authorizing direct care services
among different waivers.
(12) Report on the circumstances of dual eligibility for
Medicare and Medicaid for an individual with disabilities,
and any issues that this raises for the recipient in
coordinating provider networks and benefits.
(13) Evaluate possible cost savings associated with
changes to waivers, including the costs of changes that would
address barriers to access.
(14) Make recommendations on actions that the Department
of Human Services, Department of Health or other State
agencies could take to better meet the needs of people who
need home and community-based services.
(15) Make legislative recommendations on actions that
the General Assembly could take to improve access to Home and
Community-Based Services waivers.
(16) Collect and evaluate data, including satisfaction
surveys, interviews with waiver recipients and interviews
with advocates of Home and Community-Based Services waivers;
and be it further
RESOLVED, That the Joint State Government Commission convene
an advisory committee which contains the following members:
(1) The Secretary of Health or a designee.
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(2) The Secretary of Human Services or a designee.
(3) One member of the Senate designated by the President
pro tempore of the Senate.
(4) One member of the Senate designated by the Minority
Leader of the Senate.
(5) One member of the House of Representatives
designated by the Speaker of the House of Representatives.
(6) One member of the House of Representatives
designated by the Minority Leader of the House of
Representatives.
(7) A representative from the Office of Medical
Assistance Programs.
(8) A representative from ODP.
(9) A representative from OLTL.
(10) A representative of a county assistance office or a
designee.
(11) A representative of an association of community
providers of long-term-care living services in this
Commonwealth.
(12) A representative from two separate disability
advocacy groups in this Commonwealth.
(13) A representative of an organization representing
members of a union that provide services to individuals
receiving a Home and Community-Based Services waiver.
(14) A representative of a health plan.
(15) A representative of a hospital.
(16) A member of the Statewide Independent Living
Council.
(17) A consumer representative from the Long-Term
Services and Supports subcommittee of the Medical Assistance
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Advisory Committee.
(18) A representative of the Long-Term Care Council.
(19) A family member of an individual who receives a
Home and Community-Based Services waiver.
(20) An individual receiving services from a Home and
Community-Based Services waiver administered by ODP.
(21) An individual receiving services from home and
community-based services administered by OLTL.
(22) A representative of the Employment First Oversight
Commission.
(23) A representative of an organization that offers
personal assistance services or attendant care.
(24) A representative who is a service coordinator who
serves the OBRA waiver population.
(25) A representative who is a service coordinator who
serves the Community HealthChoices Waiver population.
(26) A health care economist.
(27) Any other representatives who are deemed
appropriate by the Joint State Government Commission;
and be it further
RESOLVED, That the advisory committee be dissolved no later
than six months after the reporting of findings concludes; and
be it further
RESOLVED, That the Joint State Government Commission report
its findings and recommendations to the House of Representatives
no later than 24 months after the adoption of this resolution.
DIRECTING THE JOINT STATE GOVERNMENT COMMISSION TO CONDUCT A
STUDY AND ISSUE A REPORT ON HOME AND COMMUNITY-BASED SERVICES
PROVIDED TO INDIVIDUALS WITH PHYSICAL DISABILITIES,
INTELLECTUAL DISABILITIES, AUTISM AND OTHER DEVELOPMENTAL
DISABILITIES WITH A FOCUS ON STREAMLINING THE APPLICATION
PROCESS AND IMPROVING SERVICE DELIVERY.
WHEREAS, IN THIS COMMONWEALTH, ALMOST 3 MILLION INDIVIDUALS
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HAD A DISABILITY AS OF 2022, AND, AS OF 2024, APPROXIMATELY
166,356 INDIVIDUALS RECEIVED SERVICES THROUGH HOME AND
COMMUNITY-BASED SERVICES (HCBS) WAIVERS; AND
WHEREAS, HCBS WAIVERS ARE WAIVER-FUNDED SERVICES OR WAIVER
PROGRAMS UNDER WHICH THE CENTERS FOR MEDICARE AND MEDICAID
SERVICES WAIVES CERTAIN MEDICAID RULES FOR INSTITUTIONAL CARE,
ALLOWING STATES, INCLUDING THIS COMMONWEALTH, TO USE MEDICAID
FUNDS TO HELP INDIVIDUALS WITH DISABILITIES REMAIN IN HOME AND
COMMUNITY-BASED SETTINGS RATHER THAN BE ADMITTED TO LONG-TERM
CARE FACILITIES; AND
WHEREAS, THE DEPARTMENT OF HUMAN SERVICES ADMINISTERS HCBS
WAIVERS THROUGH MULTIPLE PROGRAM AREAS; AND
WHEREAS, THE DEPARTMENT OF HUMAN SERVICES ADMINISTERS THE
COMMUNITY LIVING WAIVER, THE CONSOLIDATED WAIVER, THE
PERSON/FAMILY-DIRECTED SUPPORT WAIVER AND THE ADULT AUTISM
WAIVER, WHICH PROVIDE ESSENTIAL SERVICES TO CHILDREN AND ADULTS
WITH INTELLECTUAL DISABILITIES, DEVELOPMENTAL DISABILITIES AND
AUTISM; AND
WHEREAS, HCBS WAIVER SERVICES FOR CHILDREN AND ADULTS WITH
INTELLECTUAL DISABILITIES, DEVELOPMENTAL DISABILITIES AND AUTISM
MAY INCLUDE COMMUNITY INCLUSION, TRANSITION SERVICES, COMPANION
SERVICES, DAY AND RESIDENTIAL HABILITATION, HOME ADAPTATIONS,
HOUSING AND TENANCY SUSTAINING SERVICES AND IN-HOME AND
COMMUNITY SUPPORTS; AND
WHEREAS, THE DEPARTMENT OF HUMAN SERVICES ALSO ADMINISTERS
THE OMNIBUS BUDGET RECONCILIATION ACT WAIVER, KNOWN AS THE OBRA
WAIVER, WHICH SUPPORTS ADULTS WITH DEVELOPMENTAL DISABILITIES,
AND COMMUNITY HEALTHCHOICES, WHICH SUPPORTS OLDER ADULTS AND
ADULTS WITH PHYSICAL DISABILITIES; AND
WHEREAS, THE DEPARTMENT OF HUMAN SERVICES ALSO ADMINISTERS
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THE INFANTS, TODDLERS AND FAMILIES WAIVER, WHICH SUPPORTS
INFANTS AND TODDLERS FROM BIRTH TO THREE YEARS OF AGE WHO ARE
EXPERIENCING CERTAIN DEVELOPMENTAL DELAYS, NEED EARLY
INTERVENTION AND MEET AN INTERMEDIATE CARE FACILITY LEVEL OF
CARE; AND
WHEREAS, IN 2024, 8,488 PARTICIPANTS WHO WERE 18 TO 64 YEARS
OF AGE AND ENROLLED IN THE COMMUNITY LIVING WAIVER, THE
CONSOLIDATED WAIVER, THE PERSON/FAMILY-DIRECTED SUPPORT WAIVER
AND THE ADULT AUTISM WAIVER WERE EMPLOYED IN COMPETITIVE
INTEGRATED SETTINGS EARNING AT LEAST MINIMUM WAGE, COMPARED TO
1,028 SIMILARLY AGED INDIVIDUALS ENROLLED IN COMMUNITY
HEALTHCHOICES WHO WERE EMPLOYED IN COMPETITIVE INTEGRATED
EMPLOYMENT; AND
WHEREAS, HCBS WAIVERS PLAY A VITAL ROLE IN EMPOWERING
INDIVIDUALS WITH DISABILITIES TO MAINTAIN INDEPENDENCE AND
ENGAGE MEANINGFULLY IN THEIR COMMUNITIES; THEREFORE BE IT
RESOLVED, THAT THE HOUSE OF REPRESENTATIVES DIRECT THE JOINT
STATE GOVERNMENT COMMISSION TO CONDUCT A STUDY AND ISSUE A
REPORT ON HOME AND COMMUNITY-BASED SERVICES PROVIDED TO
INDIVIDUALS WITH PHYSICAL DISABILITIES, INTELLECTUAL
DISABILITIES, AUTISM AND OTHER DEVELOPMENTAL DISABILITIES WITH A
FOCUS ON STREAMLINING THE APPLICATION PROCESS AND IMPROVING
SERVICE DELIVERY; AND BE IT FURTHER
RESOLVED, THAT, IN CONDUCTING THE STUDY, THE JOINT STATE
GOVERNMENT COMMISSION MAY CONSULT WITH ORGANIZATIONS THAT HAVE
EXPERTISE IN HCBS WAIVERS FOR INDIVIDUALS WITH PHYSICAL
DISABILITIES, INTELLECTUAL DISABILITIES, AUTISM AND OTHER
DEVELOPMENTAL DISABILITIES; AND BE IT FURTHER
RESOLVED, THAT, IN CONDUCTING THE STUDY, THE JOINT STATE
GOVERNMENT COMMISSION CONSULT WITH ALL OF THE FOLLOWING:
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(1) THE DEPARTMENT OF HUMAN SERVICES, INCLUDING COUNTY
ASSISTANCE OFFICES.
(2) PROVIDERS OF HCBS SERVICES, INCLUDING COMMUNITY
PROVIDERS OF LONG-TERM CARE SERVICES AND REHABILITATION
SERVICES.
(3) ADVOCACY GROUPS IN THIS COMMONWEALTH THAT SERVE THE
AFFECTED POPULATION.
(4) THE STATEWIDE INDEPENDENT LIVING COUNCIL.
(5) ORGANIZATIONS THAT PROVIDE HOMEMAKER AND CHORE
SERVICES.
(6) ORGANIZATIONS THAT PROVIDE PERSONAL ASSISTANCE
SERVICES.
(7) SERVICE COORDINATORS.
(8) SUPPORTS BROKERS.
(9) INDIVIDUALS ENROLLED IN HCBS WAIVERS.
(10) THE EMPLOYMENT FIRST OVERSIGHT COMMISSION.
(11) ANY OTHER REPRESENTATIVES THAT THE JOINT STATE
GOVERNMENT COMMISSION DEEMS APPROPRIATE;
AND BE IT FURTHER
RESOLVED, THAT THE STUDY, BY PROGRAM AREA AND BY EACH HCBS
WAIVER, INCLUDE ALL OF THE FOLLOWING:
(1) AN ANALYSIS OF DELAYS AND DIFFERENCES IN THE
APPLICATION PROCESS AND THE PROVISION OF SERVICES.
(2) A COMPARISON OF ADMINISTRATIVE STRUCTURE,
ELIGIBILITY AND SERVICES OFFERED.
(3) AN EVALUATION AND COMPARISON OF WAGES, PAYMENT AND
BENEFIT STRUCTURE FOR DIRECT CARE STAFF, INCLUDING ALL OF THE
FOLLOWING:
(I) FACTORS THAT CONTRIBUTE TO DIFFERENCES BETWEEN
PROGRAMS.
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(II) THE NEEDS OF THE POPULATIONS SERVED.
(III) FREQUENCY OF RATE REVIEWS AND WAGE
ADJUSTMENTS.
(IV) UTILIZATION OF SHIFT WORKERS.
(V) ANY OTHER FACTOR THAT THE JOINT STATE GOVERNMENT
COMMISSION DEEMS NECESSARY.
(4) AN IDENTIFICATION OF BARRIERS TO AND DIFFERENCES IN
ACCESSING SERVICE COORDINATORS, SUPPORTS BROKERS, SUPPORTS
COORDINATORS, HOMEMAKER AND CHORE SERVICES AND PERSONAL
ASSISTANCE SERVICES.
(5) AN ASSESSMENT AND COMPARISON OF ADMINISTRATIVE
BURDENS FACED BY SERVICE COORDINATORS AND SUPPORTS
COORDINATORS IN HELPING INDIVIDUALS ACCESS SERVICES.
(6) AN EVALUATION OF THE AVAILABILITY OF HOUSING
TRANSITION AND TENANCY SUSTAINING SERVICES, COMMUNITY
INCLUSION, PARTICIPATION AND COMPANION SERVICES, DAILY LIVING
SUPPORTS, DAY AND RESIDENTIAL HABILITATION AND HOME
ADAPTATIONS.
(7) AN EXAMINATION OF CONTRIBUTING FACTORS TO ANY
DISPARITY IN COMPETITIVE INTEGRATED EMPLOYMENT OF
INDIVIDUALS.
(8) AN EVALUATION AND COMPARISON OF WAYS IN WHICH OTHER
STATES HAVE DEFINED "DEVELOPMENTAL DISABILITIES," INCLUDING
USE OF THE FEDERAL DEFINITION, AND HOW THOSE DEFINITIONS HAVE
IMPACTED THE DELIVERY OF SERVICES.
(9) A REVIEW OF THE ADMINISTRATION OF HCBS WAIVERS,
WAIVER SERVICES AND SERVICE QUALITY, INCLUDING THROUGH
FEEDBACK FROM WAIVER PARTICIPANTS AND THEIR GUARDIANS AND
PARENTS.
(10) RECOMMENDATIONS TO IMPROVE ACCESS AND UNIFORM
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AVAILABILITY;
AND BE IT FURTHER
RESOLVED, THAT THE JOINT STATE GOVERNMENT COMMISSION SUBMIT A
REPORT OF ITS FINDINGS AND RECOMMENDATIONS TO THE MAJORITY
LEADER AND THE MINORITY LEADER OF THE HOUSE OF REPRESENTATIVES
AND THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE HUMAN
SERVICES COMMITTEE OF THE HOUSE OF REPRESENTATIVES NO LATER THAN
24 MONTHS AFTER THE ADOPTION OF THIS RESOLUTION.
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