PA’s Medicaid program funds vital in-home and community services for children with medical complexities and developmental disabilities, including in-home nursing, home health aides, behavioral aides and waivers. However, top officials with the federal agency that oversee Medicaid (CMS) and Members of Congress (especially the House Energy and Commerce committee) are claiming that these Medicaid-funded in-home services are “rife with fraud,” especially when families are paid to provide care -- an allegation with which we strongly disagree. To learn more, click here.
FEDS FOCUS ON FRAUD IN MEDICAID HOME CARE & WAIVERS WHILE CUTS LOOM
April 21, 2026
As the debate over access to and affordability of health care intensifies in advance of the Congressional midterm elections, a coordinated effort is underway between members of the majority leadership of the US House and the federal Medicaid agency to turn attention from access and affordability to Medicaid fraud. Of particular concern to families of children who rely on Medicaid-funded home care and waivers is the focus of the federal fraud allegations on home care and waivers. Medicaid fraud is a serious problem that takes money away from services children need. Pennsylvania has recognized that and has been addressing it aggressively for some time.
Despite those successes, the US House Committee that is responsible for Medicaid legislation and oversight started an inquiry into potential Medicaid fraud in Pennsylvania involving home health, waivers, behavioral health, and some other Medicaid services without good reason. They have asked for a large number of reports and data from the Department of Human Services. At the same time, the federal agency that administers Medicaid (Centers for Medicare and Medicaid Services or CMS) has recently announced a new approach to fraud that will rely more heavily on options to pause or withhold significant amounts of federal funding in cases of potential fraud, which could have broad implications for Pennsylvania’s Medicaid program and the individuals that rely on it. To learn more, click here.
HOME AND COMMUNITY-BASED SERVICES (HCBS) WAIVERS: HOW AVAILABLE WILL THEY BE TO CHILDREN WITH DEVELOPMENTAL DISABILITIES?
February 21, 2026
Background:
For decades, the federal Medicaid program has assisted states in funding community-based disability services and supports for people with disabilities who, without such services, would need institutional care. States can choose who will be eligible and what services they will provide in these programs (referred to as “waiver” programs), and how many people they can afford to serve. Many of these programs have long waiting lists. This past summer, Congress cut billions of dollars from the Medicaid program. While federal law continues to allow states to use their more limited funds to run these community-based programs if they so choose, the severe cuts to Medicaid have made it necessary for states to consider cutting back on optional programs like waiver programs.
Since the 1980s, Pennsylvania has been using Medicaid funds to provide a wide range of waiver services to distinct subsets of the disability community. Some of these waiver programs, described below, have been available to children, to the extent that funds have allowed. Due to long waiting lists and a false belief that children can be fully served by other programs, children make up a very small percentage of the tens of thousands of people served. Still, for the small number of children included, the waivers provide incredibly important supports that are enabling these children to grow up in their family homes and communities. To learn more, click here.
IMPACT OF FEDERAL CUTS ON CHILDREN’S FINANCIAL ELIGIBILITY FOR MEDICAL ASSISTANCE
February 15, 2026
Many middle-class children with disabilities in Pennsylvania are enrolled in Medical Assistance (also known as Medicaid) and rely upon critical Medical Assistance-funded services that enable them to live and thrive in their homes and communities. As explained in our Impact Alerts on home health, medical equipment and behavioral health, Medical Assistance covers a wide range of services and supports for children with developmental disabilities and complex medical conditions, including services that are not covered by private insurance. For children who have private insurance, Medical Assistance also provides co-payments for hospital stays, surgeries, and other expensive treatments that many working families simply cannot afford. To learn more, click here.
CHILDREN’S BEHAVIORAL HEALTH SERVICES
February 13, 2026
In Pennsylvania, Medicaid, also called Medical Assistance (or MA), pays for tens of thousands of children to receive needed behavioral health services at no cost to their parents, and often in their own homes, schools, and communities. When behavioral health services are determined by a doctor and an MA health plan to be medically necessary, they may include outpatient therapy, in-home aides, behavior consultants, school or community aides, specialized autism treatment, medication management, residential treatment programs, acute care hospital stays, and more. The home and community-based services are called by different names, e.g., wraparound, Intensive Behavioral Health Services (IBHS), Applied Behavior Analysis (ABA), outpatient therapy, partial hospitalization, and so on. If your child is receiving behavioral health services with no copayment or deductible, their services are most likely being funded, in full or in part, by Medicaid. To learn more, click here.