Before you call: what to gather

You need specific documents to prove your identity, medical needs, and financial status before you start the application process. The County Assistance Office (CAO) reviews your income and resources to ensure you meet the limits. Gather your Medicare and Medicaid cards, state ID, and proof of income. You also need bank statements and tax returns to prove your financial history.

The state enforces a 5-year look-back period on all asset transfers. This means the CAO will check your records to see if you gave away money or property for less than fair market value. Have your primary care doctor’s contact information ready. The state will send your doctor a form to certify your medical need for care. Finally, make a detailed list of your loved one’s daily-living needs so you can describe them accurately during the in-home assessment.

The 8 steps to apply

The application process for the Community HealthChoices waiver involves multiple state agencies. The process takes a few months, but it should not exceed 90 days from your first call to final approval.

1. Call the Independent Enrollment Broker (IEB) at 1-877-550-4227. The IEB is run by Maximus and handles the intake process.
2. The IEB sends a Physician Certification form to the applicant’s doctor. The doctor marks whether the applicant is Nursing Facility Clinically Eligible (NFCE), Nursing Facility Ineligible, or ICF/ORC, and should return it within 5 business days.
3. An IEB representative conducts a first in-person visit within 7 business days of contact. They visit your home, hospital, or nursing facility to explain the program, discuss plan choices, and help with the financial Medicaid application.
4. An assessor from the local Area Agency on Aging conducts a second in-person visit within 10 business days. In Philadelphia, this is the Philadelphia Corporation for Aging (PCA). They perform the Functional Eligibility Determination (FED).
5. The IEB reviews the FED and the Physician Certification. If both indicate the applicant is NFCE, the person is functionally eligible.
6. If there is a disagreement between the forms, the Office of Long Term Living (OLTL) Medical Director reviews the file. No extra documents are requested from the applicant at this stage.
7. The IEB sends form PA 1768 to your local CAO to confirm medical eligibility.
8. The CAO reviews your income, resources, and 5-year look-back history. Once approved, Medicaid coverage begins on the date of application.

Ready to start services after your approval? Call New Century Home Care at 215-974-0000 or contact New Century Home Care using our online form (select “I am a client” and “I need services”).

The Functional Eligibility Determination: what the PCA assessor asks

The PCA assessor visits your home to determine if your loved one is NFCE. They evaluate cognition and activities of daily living based on the person’s condition over the last three days. The state groups these needs into two categories.

To qualify under Group 1, the applicant must need hands-on help with at least three ADLs. These include bathing, personal hygiene, dressing, walking, toileting, and eating. Being bed bound, in a coma, or frequently incontinent of bowel also qualifies a person under Group 1.

To qualify under Group 2, the applicant must meet at least three of these: hands-on help with two ADLs; mild to severe cognitive impairment; memory problems; confused or disorganized thinking; behavioral symptoms such as wandering or aggression; using a wheelchair or scooter; needing significant help managing medications.

The FED ignores the need for supervision or cueing. It also ignores help with meal preparation, shopping, and housekeeping. Because of this, people with cognitive impairment may be wrongly denied. Have a caregiver present during the assessment to describe a typical bad day honestly. Give all medical information to the assessor during this visit, as the OLTL Medical Director will not request extra documents later.

The financial part: COMPASS or PA 600L, County Assistance Office review

The CAO determines your financial eligibility requirements. You can apply using the paper PA 600L form during your IEB visit, or you can apply online at the COMPASS website.

The income limit for the CHC waiver is 300% of the SSI Federal Benefit Rate. For 2026, this is $2,982 per month. The CAO counts only the applicant’s gross income. The spouse’s income does not count toward the applicant’s limit. If the applicant’s income is over the limit, they may still qualify by setting up an income trust.

The resource limit is $8,000 for an unmarried applicant. If the applicant lives with their own child under 21, there is no resource limit. For married couples, the CAO uses a spousal impoverishment formula. The community spouse keeps at least $32,532 in 2026, while the applicant keeps $8,000.

The CAO excludes certain assets from this limit. These include the home the applicant lives in, one motor vehicle, irrevocable burial accounts, and life insurance without cash value. The non-applying spouse’s pension or retirement account is also excluded. The CAO reviews tax returns and bank records for the prior 5 years to check for asset transfers. Transfers for less than fair market value can cause a penalty period of ineligibility. Pennsylvania can also recover the costs of waiver services from the estate of a recipient age 55 or older, so families should consult an elder law attorney regarding estate recovery rules.

Choosing a CHC plan during the application

During the application, you must select a managed care plan to manage your physical health and waiver services. The Southeast zone includes Philadelphia, Bucks, Chester, Delaware, and Montgomery counties. You can choose from three plans: Keystone First CHC (the AmeriHealth Caritas brand in the Southeast), Pennsylvania Health & Wellness, or UPMC Community HealthChoices.

You can review plan details at www.enrollchc.com. If you do not choose a plan, the state will auto-assign one to you. You have the right to switch plans at any time after approval.

After approval: service coordinator, service plan, choose New Century

Once the CAO approves your application, your chosen CHC plan assigns a service coordinator. The coordinator creates a person-centered service plan. This plan dictates which services you receive and how many hours are approved per week.

Approved services can include Personal Assistance Services, non-medical transportation, home-delivered meals, and home adaptations. Personal Assistance Services cover help with eating, bathing, dressing, and routine health support.

You can then select an agency to provide your care. New Century Home Care is a licensed provider working with PCA, Keystone First, and AmeriHealth Caritas. We serve Philadelphia and surrounding counties. Our office staff speak English, Russian, and Ukrainian. If you want to get paid to care for your family member, you can work as a caregiver through the agency model or the participant-directed Services My Way option. Note that the CHC waiver will not pay services furnished by the participant’s spouse, legal guardian, representative payee or power of attorney.

If you’re denied

If the state denies your application, you have the right to appeal. Eligibility denials or terminations go to a Department of Human Services (DHS) Fair Hearing.

You must appeal in writing within 30 days of the notice. If you are already receiving services and facing termination, you must appeal within 15 days to keep your services in place during the process. The hearing happens by phone or in person before an Administrative Law Judge.

If you need free legal help to appeal the Medicaid decision, call the Pennsylvania Health Law Project (PHLP) Helpline at 1-800-274-3258. Its 2026 guide to CHC waiver eligibility is the main source for the steps on this page.

Not applying for long-term care?

If you do not need long-term services and supports but are on Medicare and financially eligible, you apply for regular Medicaid coverage through the CAO instead of the IEB. That coverage does not include home care hours; our PA Medicaid home care overview explains the difference. Apply online via COMPASS, call 1-866-550-4355, or visit the CAO in person.

Need help starting home care services in Philadelphia? Call New Century Home Care at 215-974-0000 or fill out our online form and select “I am a client” followed by “I need services.”