Melinda Piechoski, RN Β· RN Director of Nursing Β· PA License RN641214
40+ years clinical experience in home health and geriatric nursing Β· May 2026
Families navigating care decisions for an aging parent or medically complex loved one often ask the same question: who actually qualifies for home health care services? The answer depends on the payer source (Medicare, Medicaid, private insurance, or private pay), the individual’s functional needs, and whether skilled or non-skilled care is required. This guide explains the most common eligibility pathways for home health care in Pennsylvania.
What Is Home Health Care?
Home health care is a broad category of professional services delivered in a person’s home rather than in a hospital, nursing facility, or clinic. It includes both skilled care (nursing, therapy, wound care) and non-skilled care (assistance with bathing, dressing, meal preparation, and companionship).
Not all home care is the same. Skilled home health care is ordered by a physician and typically covered by Medicare or Medicaid when specific medical criteria are met. Non-skilled home care, also called personal care or companion care, focuses on daily living support and is commonly funded through Medicaid waiver programs, long-term care insurance, or private pay. Understanding which type your loved one needs is the first step toward finding coverage.
Medicare Requirements for Home Health Care
Medicare covers home health care services when the following conditions are met:
- The person is under the care of a doctor who certifies a plan of care and reviews it every 60 days.
- The person meets Medicare’s homebound criteria, meaning they have a normal inability to leave the home without considerable effort or the assistance of another person or device. Leaving for medical appointments, adult day programs, or brief outings does not disqualify someone from homebound status.
- The person needs at least one skilled service on an intermittent basis: skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy.
- The home health agency is Medicare-certified.
Medicare-covered services may include skilled nursing visits, physical therapy, occupational therapy, speech therapy, medical social services, and home health aide visits when combined with a skilled service. Medicare does not cover 24-hour care, meal delivery, homemaker services, or personal care when those are the only services needed.
Medicaid and Community HealthChoices in Pennsylvania
Pennsylvania’s primary Medicaid-funded home care program is Community HealthChoices (CHC). CHC provides long-term services and supports to adults age 21 and older who meet both financial and functional eligibility requirements.
Financial eligibility is based on income and asset limits consistent with Pennsylvania Medical Assistance rules. Functional eligibility requires that the person needs assistance with at least one activity of daily living (ADL), such as bathing, dressing, toileting, eating, or transferring.
CHC covers a broad range of home and community-based services, including:
- Personal care assistance (bathing, dressing, grooming, hygiene)
- Companion care and daily supervision
- Skilled nursing oversight and visits
- Participant-directed options, including the Family Caregiver Program that allows family members to get paid for providing care
A-Team Home Care is an in-network Community HealthChoices provider serving Philadelphia and Bucks County. Eligible Medicaid members receive services at no out-of-pocket cost. For questions about Medicaid CHC eligibility, call (215) 490-9994.
Other Eligibility Pathways for Home Care in Pennsylvania
Several additional programs may fund home health care for qualifying individuals:
- Veterans benefits: The VetAssist Program and VA Aid and Attendance benefit provide funding for eligible veterans and surviving spouses. Benefits can reach up to $2,229 per month. Learn more on our veterans home care page.
- Long-term care insurance: Most long-term care insurance policies cover home health care once the policyholder meets a benefit trigger, typically the inability to perform two or more activities of daily living without assistance. Review your policy’s home care provisions carefully.
- Private pay: Families who do not qualify for government programs, or who prefer to arrange care directly, can pay for services out of pocket. A-Team Home Care accepts private pay clients.
- Medicare Advantage plans: Many Medicare Advantage plans include supplemental home care benefits beyond what traditional Medicare covers. Contact your plan directly for benefit details.
Who Typically Needs Home Health Care Services?
Home health care is commonly needed by:
- Adults recovering from a hospitalization, surgery, or stroke who need skilled nursing or therapy at home
- Seniors with chronic conditions such as COPD, diabetes, heart failure, or Parkinson’s disease who require clinical monitoring between doctor visits
- Adults with physical disabilities who need daily assistance with personal care and activities of daily living
- Children with complex medical needs who benefit from pediatric home care nursing oversight
- Individuals with dementia or Alzheimer’s who require supervision and personal care at home
- Veterans who qualify for VA-funded in-home services
There is no single age requirement. While home health care is most commonly associated with older adults, adults of any age with qualifying medical or functional needs may be eligible for services.
How A-Team Home Care Determines Eligibility
A-Team Home Care’s intake coordinators simplify the eligibility process for Philadelphia and Bucks County families. When you call, our team will:
- Review your situation and identify which programs you may qualify for, including Medicare, Medicaid CHC, VA benefits, or private pay
- Complete a phone screening to assess current care needs and living situation
- Schedule a no-charge in-home RN assessment
- Develop a written care plan and match your family with a qualified caregiver
The intake process for private pay clients typically takes 24 to 48 hours. For Community HealthChoices members, the timeline depends on Medicaid authorization. Call (215) 490-9994 to start the process.
Explore our services: personal care, skilled nursing, Philadelphia home care, and Bucks County home care.
Frequently Asked Questions
Does Medicare cover 24-hour home care?
No. Medicare does not cover 24-hour around-the-clock home care. Medicare pays for skilled services on an intermittent basis, meaning part-time or periodic visits from a nurse or therapist. For continuous care or extended daily coverage, families must turn to Medicaid waiver programs, long-term care insurance, or private pay.
What is the income limit for Medicaid home care in Pennsylvania?
Pennsylvania Community HealthChoices eligibility is based on Medical Assistance income and asset rules. Income limits are adjusted periodically. The best way to determine eligibility is to contact your county assistance office or call A-Team Home Care at (215) 490-9994 for a free intake screening.
Can family members get paid to provide home care in Pennsylvania?
Yes. Pennsylvania’s Community HealthChoices program includes a participant-directed option that allows qualifying individuals to hire a family member (other than a spouse) as a paid caregiver. The Family Caregiver Program through A-Team Home Care makes this arrangement straightforward. Call (215) 490-9994 to learn more.
What is the difference between home health care and home care?
Home health care typically refers to skilled medical services ordered by a physician, such as nursing visits, wound care, and physical therapy. Home care (also called personal care or companion care) refers to non-medical support with daily activities like bathing, dressing, and meal preparation. Many families need both; A-Team Home Care provides both categories of service under one roof.
