PA Medicaid Waiver Documents: What Families Need to Gather

Melinda Piechoski, RN · Director of Nursing · May 2026

Pennsylvania’s Medicaid waiver programs can pay for home care services that allow older adults and people with disabilities to stay at home instead of moving to a facility. But accessing those benefits requires paperwork. Families who show up to their Medicaid intake appointment with the right documents in hand move through the process significantly faster than those who have to go back and gather records.

This guide covers what documents are typically needed for the two main Medicaid home care pathways in Pennsylvania: Community HealthChoices (CHC) and the OBRA Waiver for people with intellectual disabilities and autism.

Why Pennsylvania Medicaid Waiver Documentation Matters

Medicaid eligibility in Pennsylvania is based on three things: financial need, functional need, and residency. Each of those three areas requires its own supporting documents. Missing one category can delay approval by weeks, since the county assistance office will request the missing items separately.

The faster families gather these materials, the sooner care can begin. For families already managing a loved one’s declining health while working full-time, that timeline matters. Our Philadelphia home care team walks families through the process at no cost, but the documents themselves must come from you.

Proof of Identity and Residency

These documents confirm who your loved one is and that they live in Pennsylvania.

• Government-issued photo ID — Driver’s license, state ID card, or U.S. passport. Expired IDs may be accepted with additional documentation; confirm with the county assistance office.
• Social Security card — The original or a replacement card from the Social Security Administration. The number will be verified against federal records.
• Proof of PA residency — A utility bill, bank statement, or lease agreement showing the Pennsylvania address. Must be dated within the last 60 days.
• Birth certificate — Required to verify age, which affects benefit level and program eligibility.
• Medicare card — If your loved one is enrolled in Medicare, bring the card. Community HealthChoices coordinates with Medicare, and enrollment status affects how services are billed.

Financial Documents

Pennsylvania’s Medicaid program uses a financial eligibility test. For Community HealthChoices, the income limit is tied to the federal poverty level and the asset limits are strict. Gather the following:

• Proof of income — Recent Social Security award letter, pension statement, or any 1099 or W-2 showing income received. The letter must be current; older award letters are often rejected.
• Bank statements — Two to three months of statements from all checking and savings accounts. Medicaid counts “countable assets,” which includes most bank account balances.
• Investment and retirement account statements — 401(k), IRA, and brokerage account statements. Some retirement accounts are exempt; others count toward the asset limit.
• Life insurance policy documents — Policies with a cash value above a certain threshold count as a countable asset. Bring the declarations page showing cash surrender value.
• Deed or property documents — Primary residence is generally exempt, but secondary properties are not. If your loved one owns a second property, bring the deed and a current assessed value.
• Recent tax return — The prior year’s federal tax return or a statement of non-filing if your loved one did not file.

Medical and Functional Need Documents

Community HealthChoices is a nursing facility level of care program, which means applicants must demonstrate that they have enough functional limitations to qualify for nursing home care but prefer to remain at home.

• Physician statement or letter of medical necessity — A letter from the primary care doctor or specialist documenting diagnoses, functional limitations, and the need for personal care assistance. This is one of the most important documents and often takes the longest to obtain. Request it early.
• Hospital discharge summaries — If your loved one was recently hospitalized or discharged from a skilled nursing facility, include all discharge paperwork. This documents the current health situation clearly.
• Medication list — Current medications with dosages and prescribing physician names. This supports the functional assessment done by the Managed Care Organization (MCO).
• Mental health or cognitive assessment — If your loved one has dementia or another cognitive condition, a recent assessment from a physician or neurologist is helpful. Our Alzheimer’s and dementia care team can advise on what documentation is typically needed.

Insurance and Third-Party Coverage

If your loved one has any insurance in addition to Medicare, bring documentation for each policy. Medicaid is the payer of last resort, meaning it only pays after other insurance has been billed first.

• Any employer-sponsored health insurance (active or COBRA)
• Medicare Supplement (Medigap) policy
• Long-term care insurance policy
• Veterans benefits documentation if applicable

Our Bucks County home care and skilled nursing coordinators can review your insurance picture before the Medicaid application is filed to avoid billing conflicts later.

Specific Documents for Community HealthChoices (CHC)

CHC is Pennsylvania’s main Medicaid managed long-term services and supports program. In addition to the documents above, the CHC enrollment process involves:

• CHC MCO enrollment form — You will choose a Managed Care Organization during enrollment. Bring the enrollment paperwork if you have already selected a plan or received a pre-enrollment packet.
• PASRR screening results — If your loved one has a mental health condition or intellectual disability, a Pre-Admission Screening and Resident Review may be required.
• Existing service authorizations — If your loved one is already receiving any state-funded home care services (OPTIONS, LIFE, or Act 150), bring those authorization letters.

How to Get Organized Before the Appointment

The most effective approach is a single accordion folder with labeled sections: identity, finances, medical, insurance, and program-specific documents. Make photocopies of everything before the appointment. County assistance offices keep originals in some situations, and you need your own records.

If any documents are missing, note what is missing and what steps are in progress. A caseworker can sometimes accept pending documentation with a follow-up date rather than rescheduling the entire appointment.

Call A-Team at (215) 490-9994 to speak with a coordinator before your CHC intake appointment. We have guided many Philadelphia and Bucks County families through this process and can tell you exactly what your specific county office typically requires.