CHC Program vs. CHC Waiver

Understanding the difference between the Community HealthChoices program and the CHC waiver saves families time and frustration. Many people assume that enrolling in a CHC plan automatically gives them home care. This is not true.

The CHC program is Pennsylvania’s Medicaid managed care system for adults 21 and older who have both Medicare and Medicaid, or who need long-term services and supports (LTSS). Most dual-eligible people get their physical health coverage through a CHC plan. According to a 2026 guide by the Pennsylvania Health Law Project (PHLP), you must apply separately and be approved for the CHC waiver to receive in-home services.

Who the Waiver Is For

You must meet three main requirements to qualify for the CHC waiver. You must be 21 or older, meet financial limits, and be Nursing Facility Clinically Eligible (NFCE). Assessors from the local Area Agency on Aging determine your functional eligibility. In Philadelphia, this agency is the Philadelphia Corporation for Aging (PCA).

The PCA assessor uses the Functional Eligibility Determination (FED), which looks at the last three days. One example that qualifies: needing hands-on help with three or more activities of daily living such as bathing, dressing or toileting. Cognitive impairment, memory problems and behavioral symptoms can also count in combination. The FED does not count the need for supervision or cueing, so people with cognitive impairment are sometimes denied; PHLP can help with an appeal. Full criteria are on our eligibility page.

The County Assistance Office (CAO) reviews your financial eligibility. The income limit is 300% of the SSI Federal Benefit Rate, which is $2,982 per month in 2026. The CAO only counts the applicant’s income. The resource limit is $8,000 for an unmarried person. The CAO also conducts a five-year look-back on financial transfers. If you exceed the income limit, you may still qualify using an income trust. Contact an elder law attorney or PHLP for help with trusts.

Services the Waiver Covers

The CHC waiver pays for services that help you live safely in the community. These services focus on daily support rather than medical treatment.

Personal Assistance Services (PAS)

Personal Assistance Services provide direct help with daily life. According to a Disability Rights PA summary, PAS includes help with eating, bathing, and dressing. It also covers cueing and supervising people who cannot safely be left alone.

Workers provide health maintenance tasks, like bowel and bladder routines, and routine support for meal planning or therapies. They can accompany you into the community for grocery shopping or pharmacy visits. PAS workers perform incidental homemaker tasks, like washing dishes from meal prep, only when no one else is available.

PAS does not include skilled nursing or home health aide services. A doctor must prescribe those separately.

If you need home care services in Philadelphia, call New Century Home Care at 215-974-0000 or fill out our contact form and choose “I am a client” then “I need services.” Our office staff speak English, Russian, and Ukrainian.

How Services Are Decided: Person-Centered Service Plan

Once you are approved for the waiver, your CHC plan assigns a service coordinator. This coordinator works with you to create a person-centered service plan (PCSP). The PCSP details exactly which waiver services you will receive and how many hours per week the plan covers.

You have the right to be involved in your service planning. If your plan denies a service or reduces your hours, it sends a written notice. The first step is a grievance with the plan: within 60 days of the letter, or within 15 days to keep current services in place while it is reviewed. After that come a fair hearing and an external review. Contact the PHLP Helpline at 1-800-274-3258 for free legal help with appeals.

Agency Model vs. Services My Way

The CHC waiver gives you two ways to manage your Personal Assistance Services. You can use an agency model or direct your own care through Services My Way.

In the agency model, you select a licensed home care agency. The agency handles hiring, background checks, and payroll. In Services My Way, you act as the employer and Tempus Unlimited processes payroll and taxes. In both models a relative can be the paid family caregiver.

The waiver will not pay services furnished by your spouse, legal guardian, representative payee, or power of attorney.

Other OLTL Programs

If the CHC waiver does not fit your situation, the Office of Long-Term Living (OLTL) offers other options.

• OBRA Waiver: Continues for some people who do not qualify for the CHC waiver.
• Act 150: A state-funded program. PHLP (1-800-274-3258) can explain who qualifies for OBRA and Act 150.
• LIFE Program: Pennsylvania’s PACE program for adults 55 and older. To join the LIFE program, you must be financially eligible, need nursing facility-level care, and live safely in a LIFE provider’s service area.

How to Get on the Waiver in Philadelphia

Applying for the CHC waiver involves several steps and multiple agencies. The process can take a few months, but it should not take more than 90 days. Read our full guide on how to apply for PA Medicaid home care for detailed instructions.

1. Call the Independent Enrollment Broker (IEB) at 1-877-550-4227 to start the application.
2. The IEB sends a Physician Certification form to your doctor, who should return it within five business days.
3. An IEB representative visits you within seven business days to help with the financial Medicaid application.
4. A PCA assessor visits within 10 business days to complete your functional eligibility determination.
5. The IEB reviews your functional status, and the CAO reviews your financial application. Once approved, your Medicaid coverage begins on the date of application.

Ready to start home care? Call New Century Home Care at 215-974-0000 or fill out our contact form and select “I am a client” then “I need services.”