Quick answer: To qualify for Medicaid home care in Pennsylvania through the Community HealthChoices (CHC) waiver, your loved one must meet a dual test: a medical need for nursing facility level of care and financial eligibility under Medicaid’s income and asset rules.
If your loved one needs help at home but you are worried about how to pay for it, Pennsylvania’s Community HealthChoices (CHC) program may be the answer you have been looking for. CHC is Pennsylvania’s Medicaid-managed long-term services and supports program. It pays for home care services that allow older adults and people with physical disabilities to stay in their own homes rather than moving to a nursing facility. The program covers a wide range of services, from personal care assistance to companion services, and it does so at little or no cost to eligible participants.
Understanding who qualifies, what is covered, and how to apply can feel complicated. This guide breaks it down in plain language so you and your family can make informed decisions. A-Team Home Care has been helping Philadelphia-area families access home care services for years, and we see firsthand how life-changing the right program can be.
What Is Community HealthChoices (CHC)?
Community HealthChoices is Pennsylvania’s statewide Medicaid program that combines physical health care and long-term services and supports (LTSS) into one managed care plan. It replaced the older waiver programs, including the Pennsylvania Department of Aging Waiver and the Attendant Care Waiver, and rolled them into a single, coordinated system.
The program is administered by the Pennsylvania Department of Human Services (DHS) and delivered through managed care organizations (MCOs). The three statewide MCO plans are Keystone First, UPMC Community HealthChoices (UPMC CHC), and PA Health & Wellness. Participants choose an MCO, and that MCO coordinates all of their covered services, including home-based care.
The core goal of CHC is straightforward: help people who would otherwise need nursing home care stay safely in the community, in their own homes or the homes of family members. If your loved one qualifies, CHC can pay for the in-home caregiver who helps them bathe, dress, manage medications, prepare meals, and more. For many families in the Philadelphia region, this is the program that makes home care financially possible.
It is worth understanding how CHC differs from Medicare home health services before assuming one program covers what you need. Our article on Medicare vs. Medicaid home care in Pennsylvania explains those differences in depth.
Who Is Eligible for CHC in Pennsylvania?
Eligibility for Community HealthChoices rests on three main pillars: age or disability status, financial qualifications, and level of care need. A person generally needs to meet criteria in all three areas to participate in the program.
Age and Enrollment Status
- Adults age 21 and older who are enrolled in both Medicare and Medicaid (dual eligible), OR
- Adults age 21 and older who qualify for Medicaid long-term services and supports because they need a nursing facility level of care
Note that CHC is specifically designed for adults with physical disabilities or age-related needs. It is a separate track from programs that serve people with intellectual disabilities or autism. If you have a family member with autism-related support needs, our autism home care resource covers programs that are more specifically designed for that population.
Financial Eligibility
CHC is a Medicaid program, so participants must meet Pennsylvania’s income and asset requirements. Income limits are tied to the federal poverty level and Supplemental Security Income (SSI) guidelines. Asset limits also apply, though certain assets, like a primary home, a vehicle, and personal belongings, are typically not counted.
Pennsylvania does offer a “spend-down” pathway for people whose income is slightly above the standard limit. Under this approach, medical expenses can be used to reduce countable income until a person reaches the eligible threshold. Because income and asset rules can shift and depend on individual household circumstances, it is important to speak with a benefits counselor or your county assistance office to get a current, accurate picture of what applies to your situation.
You can find general Medicaid eligibility information through Medicaid.gov and more Pennsylvania-specific information through the Pennsylvania Department of Human Services.
Level of Care Need
Financial eligibility alone is not enough. A person must also demonstrate a need for nursing facility level of care. This does not mean the person has to be in a nursing home. It means a care assessor determines that, based on the person’s functional limitations and health conditions, they would qualify for nursing facility care if they were not receiving community-based supports.
This assessment is conducted by staff from the local Area Agency on Aging (AAA) or an independent assessor, depending on the county. The assessor looks at activities of daily living (ADLs), such as bathing, dressing, toileting, transferring, and eating, as well as instrumental activities of daily living (IADLs) like meal preparation, housekeeping, and medication management. If you are wondering about the signs that point to this level of need, our article on 8 signs your aging parent needs in-home care can help you recognize them early.
What Services Does CHC Cover at Home?
When a person qualifies for CHC and chooses a home-based care setting, a wide range of services can be included in their service plan. The exact services are determined by the individual’s assessed needs and the plan developed with their MCO care manager. Common covered services include:
- Personal care assistance (help with bathing, dressing, grooming, and hygiene)
- Companion and homemaker services (light housekeeping, meal preparation, transportation to appointments)
- Skilled nursing visits, when medically appropriate
- Physical, occupational, and speech therapy in the home
- Respiratory therapy and nutritional counseling
- Home modifications to support safety and accessibility
- Assistive technology and medical equipment
- Behavioral health support services
- Participant-directed services, which allow participants to have more control over who provides their care
The number of hours of home care covered each week varies based on the individual’s care plan. Some people receive a few hours of help per day, while others with higher needs may require around-the-clock assistance. If your family member needs continuous support, learn more about what 24-hour home care looks like in practice.
How the CHC Enrollment Process Works
Getting enrolled in Community HealthChoices involves several steps. The process can feel lengthy, but knowing what to expect helps families move through it more smoothly.
- Apply for Medicaid: If your loved one is not already enrolled in Pennsylvania Medicaid (also called Medical Assistance), the first step is submitting an application through the county assistance office or online through COMPASS, Pennsylvania’s benefits portal.
- Functional assessment: Once Medicaid eligibility is established, the person is referred for a functional assessment. A trained assessor visits the individual’s home to evaluate their care needs and daily functioning.
- Level of care determination: Based on the assessment, a determination is made about whether the person meets nursing facility level of care criteria.
- Choose an MCO: Eligible participants choose a managed care organization from those available in their county. Each MCO has a network of approved providers.
- Care planning: A care manager from the MCO works with the participant and their family to develop a person-centered service plan that outlines what services will be provided, how many hours, and by whom.
- Provider selection: The participant chooses a home care provider from the MCO’s network. This is where a licensed and experienced agency like A-Team Home Care comes in.
The timeline from application to receiving services varies, but families should not wait until a crisis to begin. Starting the process early, even when needs seem manageable, puts you in a much stronger position.
CHC vs. Adult Day Services: Choosing the Right Setting
Community HealthChoices does not require participants to receive care only at home. Some participants choose to attend an adult day program for part of the week and receive in-home care at other times. The right combination depends on the individual’s social needs, health requirements, and family situation.
Adult day programs offer structured activities, social interaction, and sometimes health monitoring in a group setting. In-home care provides one-on-one support in a familiar, private environment. For families weighing both options, our comparison of adult day services vs. in-home care under PA Medicaid walks through the key trade-offs.
Many families find that a blend of both works well, especially for family caregivers who need respite time during the day while still wanting their loved one at home in the evenings and on weekends.
CHC and Dementia or Cognitive Conditions
Community HealthChoices can be an excellent resource for families caring for someone with Alzheimer’s disease or another form of dementia. While CHC is not a dementia-specific program, the personal care and companion services it covers are often exactly what someone with memory loss needs to remain safely at home.
A person with dementia who also meets the financial and functional eligibility criteria for CHC can receive in-home caregiving support tailored to their stage of the disease. That might mean help with personal hygiene and dressing in the middle stages or more intensive supervision and redirection support as the disease progresses. Our Alzheimer’s home care stage-by-stage guide explains how care needs shift over time and how home-based support can adapt alongside them.
Families should also know that safety assessments and home modifications, sometimes covered under CHC, can make a real difference for someone with dementia who is at risk of falls or wandering.
Why Choose A-Team Home Care as Your CHC Provider
When a participant enrolls in Community HealthChoices and is ready to select a home care provider, they have choices. A-Team Home Care serves Philadelphia, Bucks County, and the surrounding Pennsylvania counties. Over the years, we have built a reputation for dependable, compassionate care and for helping families understand and access the programs that can pay for it.
We provide companion care, personal care, and in-home caregiver services, which align directly with the types of home-based support covered under CHC. Our team understands how Medicaid-funded home care works, how to coordinate with MCO care managers, and how to build care plans that genuinely reflect what each client needs. We are a licensed home care agency, ACHC-accredited, and recognized with the Philadelphia Inquirer Philly Favorites, the Happening List, Inc. 5000, and the Philadelphia100, which reflects our commitment to the families we serve.
We also help veterans and their surviving spouses access VA Aid and Attendance benefits. If a loved one served our country and needs care at home, we can help identify the benefits they may be entitled to. For families who want to know more about quality standards in home care, our article on ACHC accreditation and what it means for home care explains why these standards matter.
If you want to understand whether your loved one may qualify for home care services more broadly, our resource on who qualifies for home health care services covers the general landscape of eligibility criteria across programs.
Frequently Asked Questions
Does my loved one need to be in a nursing home to qualify for CHC?
No. Your loved one does not need to currently live in a nursing home to qualify. They need to meet the criteria for nursing facility level of care, meaning an assessor determines their functional limitations are significant enough that nursing home placement would be appropriate if community supports were not available. The whole point of CHC is to help people avoid nursing home placement by providing support at home.
How long does it take to start receiving home care through CHC?
The timeline varies by county and individual circumstances. The process involves a Medicaid application, a functional assessment, a level of care determination, MCO enrollment, and care planning. Families should plan for the process to take several weeks from start to finish. Starting early, before a crisis occurs, is strongly recommended. Delays in the assessment or application process are not uncommon, so patience and follow-up are important.
Can a family member be paid to provide care under CHC?
In some cases, yes. CHC offers participant-directed options that allow participants to have more say in who provides their care, and under certain conditions a family member (other than a legally responsible relative such as a spouse or legal guardian) may be hired as a paid caregiver. This arrangement requires approval through the care plan and the MCO. A care manager can explain exactly how participant direction works and whether it is a good fit for your family’s situation.
What happens if someone’s income is slightly over the Medicaid limit?
Pennsylvania has a spend-down process that may still allow someone to qualify. Under spend-down, medical expenses, including payments for home care, prescriptions, and medical bills, can be applied to reduce a person’s countable income to the eligible threshold. This process can be complicated to navigate, so working with a benefits counselor or your county assistance office is the best way to understand whether spend-down could help your family member qualify.
Can someone receive CHC home care services and also go to an adult day program?
Yes. CHC participants can receive a combination of services, and many people use both in-home care and adult day services as part of their overall plan. The specific mix is determined through the care planning process with the MCO. A care manager helps identify the combination of services that best meets the participant’s health, safety, and social needs while fitting within the plan’s approved hours and budget.
Ready to find out whether your loved one qualifies for Medicaid home care through CHC, or whether another program might be the right fit? The team at A-Team Home Care is here to help. We serve Philadelphia, Bucks County, and the surrounding Pennsylvania area, and we can walk you through your options without pressure or confusion. Call us at (215) 490-9994 or use the form below to start the conversation and take the first step toward keeping your family member safe, comfortable, and at home.
This article provides general guidance for Pennsylvania families. It is not legal, financial, or medical advice. Medicaid and VA eligibility rules change; verify current rules with the PA Department of Human Services or a qualified elder law attorney before acting.
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