Does Medicaid pay for home care in Pennsylvania?

Yes, Pennsylvania Medicaid pays for long-term home care services through a program called the Community HealthChoices waiver. Community HealthChoices (CHC) is Pennsylvania’s managed care program for adults 21 and older who have both Medicare and Medicaid, or who need long-term services and supports.

The Southeast zone, which covers Philadelphia, Bucks, Chester, Delaware, and Montgomery counties, has used this program since 2019. Most dual-eligible people get their Medicaid physical health coverage through a CHC plan. However, to get home care services, your loved one must apply separately and be approved for the CHC waiver.

What Medicaid home care covers

The CHC waiver covers a variety of services designed to keep people safe in their homes. A person-centered service plan determines exactly which services your loved one receives and how often.

For most families the core service is personal care services. Under the waiver, this includes help with activities of daily living (ADLs) such as eating, bathing, and dressing. It also covers cueing and supervising people who cannot safely be left alone, as well as routine support like meal planning.

Caregivers can perform incidental homemaker tasks, such as washing dishes from meal preparation or changing bed linens, when no one else is available to do them. Keep in mind that home health aide services and skilled nursing are separate, physician-prescribed services and are not performed by non-medical home care aides.

Need help starting services? Call New Century Home Care at 215-974-0000 or fill out our contact form. Select “I am a client” and then “I need services.” Our office staff speak English, Russian, and Ukrainian.

Who qualifies at a glance

To receive waiver services, an applicant must meet specific age, medical, and financial requirements. Here is a summary of the basic rules.

Medical eligibility is checked with the Functional Eligibility Determination: for example, needing hands-on help with three or more activities of daily living qualifies. Financial rules allow a married applicant’s spouse (the community spouse) to keep at least $32,532 in joint resources in 2026. You can find full details on these specific Medicaid eligibility rules.

How to apply in Philadelphia

The application process involves multiple agencies and assessments. It can take a few months, but it should not take more than 90 days. Here are the eight steps to apply.

1. Call the Independent Enrollment Broker (IEB) at 1-877-550-4227 to start the process.
2. The IEB sends a Physician Certification form to your loved one’s doctor, who should return it within five business days.
3. An IEB representative conducts a first in-person visit within seven business days to help with the financial Medicaid application and explain the program.
4. An assessor from the Philadelphia Corporation for Aging (PCA) conducts a second in-person visit within 10 business days to complete the Functional Eligibility Determination (FED).
5. The IEB reviews the FED and the Physician Certification. If both confirm the applicant needs nursing facility-level care, they are functionally eligible.
6. If there is a disagreement between the assessment and the doctor, the Office of Long Term Living (OLTL) Medical Director reviews the case.
7. Once medical eligibility is approved, the IEB sends form PA 1768 to the County Assistance Office (CAO).
8. The CAO reviews the applicant’s income, resources, and five-year financial history. If approved, Medicaid coverage begins on the date of application.

For more detailed instructions, read our step-by-step application guide.

The three CHC plans

Once approved for the CHC waiver, participants receive their services through one of three managed care organizations in the Southeast zone. Participants can switch plans at any time. If they do not choose a plan, the state will auto-assign one.

• Keystone First CHC: This is the AmeriHealth Caritas brand in the Southeast region, headquartered in Philadelphia.
• PA Health & Wellness: Another plan option available to Philadelphia residents.
• UPMC Community HealthChoices: The third managed care plan operating in this zone.

Can a family member be the paid caregiver?

Yes. A relative can be hired by a licensed home care agency such as New Century, or employed by the participant through the self-directed option, Services My Way, where Tempus Unlimited handles payroll and taxes.

There is one limit. The CHC waiver will not pay for services provided by the participant’s spouse, legal guardian, representative payee, or power of attorney (POA). You can learn more about the rules for getting paid to care for family if you are considering this option.

Money questions: Income limits, the 5-year look-back, and estate recovery

If your loved one’s gross income is over the $2,982 monthly limit, they may still qualify. Pennsylvania allows applicants to use an income trust to handle excess income, or they might qualify through the Medical Assistance for Workers with Disabilities (MAWD) program if they are under 65 and working. Read what to do if your income is too high.

The County Assistance Office will review the applicant’s and spouse’s financial records for the past five years. They look for assets given away or sold for less than fair market value. Such transfers can create a penalty period where Medicaid will not pay for care. Learn more about the Medicaid 5-year look-back rule.

Pennsylvania operates an estate recovery program. The state can recover the costs of waiver services, nursing home care, and related hospital or prescription costs from the estate of a recipient who was 55 or older when they received care. The state does consider surviving spouses in the home and hardship waivers. Read how estate recovery works to understand the risks.

If you are denied

If your application is denied or your services are terminated, you have the right to a Department of Human Services Fair Hearing. You must appeal in writing within 30 days of the notice date. If you are already receiving services and want to keep them in place during the appeal, you must appeal within 15 days.

A judge will hear the appeal by phone or in person. If you need legal assistance, you can contact the Pennsylvania Health Law Project (PHLP) Helpline at 1-800-274-3258 for free help with OLTL waiver appeals. Service denials by a CHC plan (for example, cut hours) follow a different path that starts with a grievance. Both are explained in our guide to appealing a Medicaid denial. You can also review the PHLP 2026 guide for detailed advocacy information.

Other routes: LIFE and Medicare

If the CHC waiver is not the right fit, other programs exist. The Living Independence for the Elderly (LIFE) program is Pennsylvania’s version of PACE. It is available to people 55 and older who meet nursing facility clinical eligibility and live safely in a LIFE provider’s service area. See our page on the PA LIFE program.

Medicare also pays for some home care, but the rules are entirely different. Medicare covers part-time or intermittent skilled care for people who are homebound, not ongoing help with daily activities on its own. We break down the difference between Medicare and Medicaid home care to clarify what each program funds.

Guide index

Use the links below to read the rest of our Pennsylvania Medicaid home care guide:

• Community HealthChoices waiver: An overview of the specific program that funds home care.
• How to apply for PA Medicaid: The exact steps to get approved in Philadelphia.
• Medicaid eligibility requirements: The medical and financial rules you must meet.
• What to do if your income is too high: Options like income trusts for those over the limit.
• Medicaid 5-year look-back rule: How the state reviews past financial transfers.
• Difference between Medicare and Medicaid home care: Why Medicare will not pay for long-term personal aides.
• How estate recovery works: How the state reclaims money from a recipient’s estate.
• Appealing a Medicaid denial: What to do if the state says no.
• PA LIFE program: An alternative managed care option for adults 55 and older.

Ready to arrange care? Call New Century Home Care at 215-974-0000 or submit our website form. Choose “I am a client” and “I need services” to get started. Our office team speaks English, Russian, and Ukrainian.