How Pennsylvania pays for disability services

Waiver inventory

Consolidated, Community Living, and P/FDS waiver amendments all took effect Jan. 1, 2026. Total ODP enrollment: about 62,000 people; 62,292 receiving intellectual disability services FY2024-25 actual, of whom 61,498 received home and community services (waiver plus base). pa.gov

State-only funded programs

• Intellectual Disabilities Community Base Program. The core state-funded stream. Base services are non-waiver home and community services delivered through county Mental Health/Intellectual Disabilities programs, which ODP describes as "Base (state funded) HCBS." Appropriation: $160,108,000 FY2024-25 actual, $167,181,000 FY2025-26 available, $174,981,000 FY2026-27 budget. With associated federal lines (Medical Assistance Community ID Services $92,434,000, SSBG Community ID Services $5,651,000, Autism Spectrum Disorder Surveillance $450,000, Disability Innovation $992,000), the subtotal is $266,708,000 for FY2025-26. Base services reached 23,889 people (unduplicated) in FY2024-25. Administered by ODP through county MH/ID programs and Administrative Entities. pa.gov and pa.gov
• Residential Habilitation Ineligible services. Department-established per diem fees paid for the portion of residential costs that are not eligible for federal Medicaid match. Rates are set by geographic Area 1 and Area 2 and by program capacity, effective July 1, 2024: Licensed Residential Habilitation Ineligible (W9001) 1 person $105.05 Area 1 and $93.64 Area 2, declining to $22.87 and $18.93 for 5 to 8 people; Unlicensed Residential Habilitation Ineligible (W7079) 1 person $28.29 and $25.16, declining to $9.58 and $7.50 for 3 people. Adult Autism Waiver Licensed Residential Habilitation Ineligible (W7233) is $37.87 per day. pa.gov
• Intellectual Disabilities State Centers. State-operated ICFs/IID at Ebensburg and Selinsgrove, plus wind-down costs at Hamburg, White Haven, and Polk. State funds $114,214,000 FY2024-25 actual, $108,230,000 FY2025-26 available, $110,114,000 FY2026-27 budget, against a total all-funds $260,991,000 for FY2025-26. pa.gov
• Autism Intervention and Services. $33,139,000 FY2024-25 actual, $37,406,000 FY2025-26 available, $35,311,000 FY2026-27 budget. Funds ACAP and the ASERT Collaborative, which develops crisis programs, family support services, and provider training. paautism.org
• ID/A Supportive Housing Pilot. Funded by the HCBS Augmentation Fund, launched March 1, 2024 in 10 counties. As of Jan. 1, 2026: 129 people enrolled, 22 transitioned off subsidy, $724 average monthly subsidy, $75,117.34 average yearly savings for people who moved out of group home residential habilitation. pa.gov

County / regional / local funding

• County Mental Health/Intellectual Disabilities programs and Administrative Entities (AEs). Pennsylvania delegates waiver operations to county-based AEs under an AE Operating Agreement with ODP. AEs handle waiver enrollment, review and completion of PUNS, provider qualification, level of care determinations, and fair hearing notices. The Consolidated waiver application specifies ODP oversight and remediation for AE performance failures, including a 90-day suspension of an AE's waiver enrollment authority. pa.gov and pa.gov
• Mechanism and scale. The Governor's Executive Budget states that "State, federal, and local funding supports community-based programs under the MH/ID Act," confirming a local funding component alongside the state Community Base Program appropriation of $167,181,000 for FY2025-26. County allocations are approved annually; ODP's historical data reports cite "Approved Primary County Allocations" and enacted budget acts as the source for non-block-grant counties' service funds and all county administration allocations. pa.gov and pa.gov
• Human Services Block Grant. Some counties administer ID/A base funds within a county human services block grant and file annual County Human Services Plans with DHS. Example: pa.gov
• Geography. Statewide, 67 counties, some operating as joinders such as Carbon-Monroe-Pike. I did not find a published county-by-county allocation table for FY2025-26 or FY2026-27, or the exact local match percentage required of counties.

Funding scale

• Total Intellectual Disabilities/Autism subcategory, all funds: $6,694,193,000 FY2024-25 actual; $7,029,278,000 FY2025-26 available; $7,338,847,000 FY2026-27 budget. pa.gov
• State vs federal split, FY2025-26 available: General Fund $3,198,634,000, federal $3,786,600,000, augmentations $44,044,000. FY2026-27 budget: General Fund $3,282,439,000, federal $4,012,364,000, augmentations $44,044,000.
• Community Waiver Program appropriation alone: $2,552,157,000 state FY2024-25 actual; $2,706,596,000 FY2025-26 available; $2,783,366,000 FY2026-27 budget, matched by federal Medical Assistance Community ID Waiver funds of $3,056,097,000, $3,213,565,000, and $3,415,795,000 respectively. That puts total waiver spending at roughly $5.92 billion for FY2025-26.
• Intermediate Care Facilities appropriation: $179,855,000 state FY2024-25 actual; $173,237,000 FY2025-26; $178,667,000 FY2026-27. All-funds subtotal $489,254,000 FY2025-26.
• Pennsylvania FY2026 FMAP: 56.06 percent. macpac.gov The FY2026-27 budget uses a full-year blended rate moving from 55.8175 percent to 57.0725 percent, which produces a $73,657,000 General Fund reduction in the Community Waiver Program line.
• Average cost per person served in the community FY2024-25 actual: Consolidated Waiver $226,754; Community Living Waiver $52,872; P/FDS Waiver $23,189; autism services $66,789.
• People served: 62,292 receiving intellectual disability services FY2024-25; 61,498 in home and community services; 42,384 living in a private home rather than a provider-controlled setting; 1,559 in private ICFs/ID; 413 in state centers; 25 moved from private ICF/ID or state centers into the community.
• Waiting list: ODP uses the PUNS instrument with three categories, Emergency, Critical, and Planning. The Shapiro Administration announced a Multi-Year Program Growth Strategy in February 2024 aimed at eliminating the adult emergency waiting list, and reported a 31 percent reduction in the adult emergency waiting list as of 2026. Three counties (Forest, Lawrence, Warren) have eliminated their adult emergency waiting lists, enrolling 134 people since February 2024. The absolute statewide emergency waiting list count was not published in any primary source I retrieved. pa.gov and pa.gov and pa.gov

Residential funding detail

Pennsylvania prices residential services on two dimensions: Needs Group 1 through 5, derived from the Supports Intensity Scale, and program capacity, meaning the number of people in the home. All rates are per day and effective July 1, 2024 through June 30, 2027. A parallel "Enhanced Communication" fee applies to people who need it.

• Licensed Residential Habilitation With Day. Needs Group 1: $433.05 (1 or 2 people), $312.16 (3), $245.99 (4), $224.75 (5 to 8). Needs Group 3: $790.99 (1), $668.54 (2), $467.35 (3), $362.42 (4), $333.29 (5 to 8). Needs Group 5: $1,341.85 (1), $1,215.16 (2), $835.46 (3), $642.84 (4), $579.75 (5 to 8).
• Licensed Residential Habilitation Without Day. Needs Group 1: $554.38 (1 or 2), down to $283.18 (5 to 8). Needs Group 5: $1,754.51 (1), $1,312.57 (2), $1,004.32 (3), $766.28 (4), $683.54 (5 to 8).
• Unlicensed Residential Habilitation. $140.44 (1 person), $88.19 (2), $63.71 (3), no needs group tiering.
• Life Sharing, over 30 hours per week on average, with day (rates effective Oct. 1, 2024): Needs Group 1 $181.63 (1 person) and $128.04 (2); Needs Group 4 $376.95 and $251.39. Without day: Needs Group 1 $200.90 and $160.45; Needs Group 4 $414.65 and $271.93.
• Life Sharing, under 30 hours per week on average. $156.49 (1 person), $111.44 (2).
• Medically Complex Life Sharing, Needs Group 4. $462.10 (1 person), $290.44 (2).
• Supported Living. Needs Group 1 $160.19 (1 person), $112.14 (2), $80.09 (3); Needs Group 4 $576.34 (1 and 2), $401.19 (3).
• Supplemental Habilitation add-on: $6.12 per 15-minute unit 1:1, $12.22 2:1.
• Adult Autism Waiver residential. Community Home per day by acuity: Light $168.87, Limited $237.09, Extensive $309.47, Intensive $600.74, Intensive Plus $709.30. Life Sharing: Low $181.57, Medium $220.48, High $259.39.
• ICF/IID. Two state centers, Ebensburg (208 residents July 2024, 196 July 2025, 196 projected July 2026, 402 beds, 48.8 percent capacity) and Selinsgrove (225, 214, 214, 473 beds, 45.2 percent). Total state center population 454 July 2024, 410 July 2025 and projected July 2026. Private ICFs/ID served 1,559 people in FY2024-25. Private ICF/ID per diem rates were not located in a published schedule.

Room and board. The Consolidated Waiver application states plainly: "Room and board is not included in the rate for the Residential Habilitation service. Residential Habilitation providers should collect room and board payments in accordance with regulatory requirements." Room and board therefore falls to the individual's own income, principally SSI. Two exceptions: room and board is included in the fee schedule rate for respite provided in a licensed residential setting, where the participant may not be charged, and for licensed or accredited camp settings. Separately, Pennsylvania pays Residential Habilitation Ineligible per diems, listed under State-only funded programs above, which are Department-established fees for the non-federally-matchable portion of residential costs and are geographically tiered into Area 1 (Bucks, Carbon, Chester, Delaware, Lehigh, Monroe, Montgomery, Northampton, Philadelphia, Pike) and Area 2 (all remaining counties).

Comparable service rates

Other notable rows from the same fee schedule: Behavioral Supports Level 1 $23.85 and Level 2 $25.55 per 15 min; Communication Specialist $18.24; Shift Nursing RN 1:1 $20.60 and LPN 1:1 $14.87; Housing Transition and Tenancy Sustaining Services $21.86; Family Medical Support Assistance $19.88; Transportation Trip Zone 1 $36.54, Zone 2 $65.78, Zone 3 $74.73.

Official rate schedule links

• Community Based Services fee schedule rates for the Consolidated, Community Living, and P/FDS Waivers, effective July 1, 2024, with the Supports Coordination table effective Jan. 1, 2027: pa.gov
• Rates for Residential Eligible and Ineligible Services, effective July 1, 2024 through June 30, 2027: pa.gov
• Adult Autism Waiver fee schedule and Department-established fees, effective July 1, 2024: pa.gov
• Agency With Choice Financial Management Services rates, excluding benefits, effective Oct. 1, 2024: pa.gov
• Agency With Choice rates, including benefits, effective Oct. 1, 2024: pa.gov
• ODP Rates landing page with assumption logs and historical rates: pa.gov
• Field Office Rate Setting: pa.gov
• Budget Adjustment Factor: pa.gov
• Performance-Based Contracting Supports Coordination implementation plan: pa.gov

Notable features and flags

• February 2024: The Shapiro Administration announced the ODP Multi-Year Program Growth Strategy to eliminate the adult emergency waiting list, working through added Consolidated and Community Living waiver capacity plus changed management of waiver capacity, paired with $214 million in proposed rate increases. pa.gov
• 2024-25 budget: $354.8 million in combined state and federal funding for ID/A. By 2026 DHS reported a 31 percent reduction in the adult emergency waiting list, more than 42,000 people receiving home and community services, and the lowest direct support professional vacancy rate since 2015. pa.gov
• Jan. 1, 2025: Performance-Based Contracting took effect for Residential Habilitation (licensed and unlicensed), Life Sharing, and Supported Living under a statewide 1915(b)(4) selective contracting waiver, adding enhanced residential rate add-ons and pay-for-performance to the fee schedule. Provider directory: pa.gov
• Jan. 1, 2026: Performance-Based Contracting extended to Supports Coordination, with a new supports coordination rate methodology replacing 15-minute billing with outcome and per-member-per-month payments effective Jan. 1, 2027. SCO directory: pa.gov
• Jan. 1, 2026: Consolidated, Community Living, and P/FDS waiver amendments took effect. The Consolidated amendment sets unduplicated capacity at 19,181 in year 1 rising to 19,906 by year 3, with reserved capacity carved out for people moving from state and private ICFs/ID and from skilled nursing facilities and psychiatric residential treatment facilities.
• FY2026-27 proposed budget: $30 million state plus $36.2 million federal to enroll up to 1,625 additional people in waiver services; also a $2,095,000 net decrease in the Autism Intervention and Services appropriation, including a $2,000,000 funding reduction. pa.gov
• State center downsizing: the state center census fell from 678 in FY2020-21 to a projected 362 in FY2026-27; Polk closed with 21 residents in July 2024 and zero thereafter; White Haven and Hamburg carry wind-down costs only. Occupancy at the two remaining centers is projected at 46.9 percent of licensed bed capacity in July 2026.
• SB 1548-equivalent transparency and pilot activity: the ID/A Supportive Housing Pilot in 10 counties reported $75,117.34 average annual savings per person who moved out of a group home, a figure DHS is using to argue for scaling the model.

Confidence

Solid: the complete fee schedules for community-based services, residential eligible and ineligible services, and the Adult Autism Waiver, all pulled directly from the ODP rate documents at procedure-code level; the appropriation lines, program measures, state center census, and per-person average costs from the 2026-27 Governor's Executive Budget; waiver capacity from the Jan. 1, 2026 Consolidated waiver application; and the room-and-board treatment, which the waiver application states explicitly. Estimated or uncertain: the Community Base Program figures are a state appropriation, not a full accounting of county-level ID/A spending, and I could not verify the required county local match percentage under the MH/ID Act beyond the budget's statement that local funding is part of the mix. Enrollment for the Infants, Toddlers and Families waiver and the OBRA waiver was not found. Could not find: the absolute statewide emergency waiting list count in any primary source, a published private ICF/ID per diem schedule, and a current county-by-county allocation table.