Pennsylvania caregiver benefits guide
Last checked: May 18, 2026
Medicaid is called Medical Assistance in Pennsylvania. It may help pay for care at home when a person needs help with daily tasks and meets program rules.
This guide is for a family caregiver who needs to know who to call, what to ask for, what papers to gather, and what to do if the first answer is no.
Quick answer
In Pennsylvania, Medicaid home care is usually handled through Medical Assistance long-term care, home and community-based services, and Community HealthChoices, called CHC. CHC is a managed care program for many adults who need long-term services and supports.
For Medicaid long-term help at home, start with the PA Independent Enrollment Broker at 1-877-550-4227. If the person is age 60 or older and you also need aging services, call the local Area Agency on Aging and ask about OPTIONS and PA Link.
Start here
- Call the PA Independent Enrollment Broker. Say that you want to apply for Medicaid long-term services and supports at home.
- Ask which route fits. Ask about CHC, LIFE, waiver services, and the County Assistance Office if Medicaid financial eligibility is not yet set.
- Write down daily care needs. List help needed with bathing, dressing, toileting, transfers, meals, laundry, rides, medicines, memory, falls, and safety.
State warning: Rules can change. Counties, managed care plans, waiver contractors, service coordinators, and agencies may use different names for the same step. Confirm current rules with Pennsylvania DHS, the PA Independent Enrollment Broker, the County Assistance Office, the managed care plan, or the local Area Agency on Aging.
Main programs and routes to check
| Program or route | Who it may help | Where to start |
|---|---|---|
| Community HealthChoices (CHC) | Adults age 21 or older who have Medicare and Medicaid, or who need Medicaid long-term services and supports because they need help with everyday personal tasks. | Call PA IEB at 1-877-550-4227. Ask to apply for long-term services and supports at home. |
| Medical Assistance long-term care and HCBS | Adults who may qualify for Medicaid payment of long-term care at home, in the community, or in a facility. HCBS means home and community-based services. | Apply through COMPASS, call 1-866-550-4355, contact the County Assistance Office, or call PA IEB for waiver services. |
| LIFE, also called PACE nationally | Some adults age 55 or older who meet care-need and financial rules, live in a LIFE service area, and can be served safely in the community. | Ask PA IEB or a local LIFE provider. You can also check the Pennsylvania LIFE program site. |
| OPTIONS Program | Pennsylvania residents age 60 or older with unmet needs that affect daily functioning. This is through the aging network, not the same as Medicaid long-term care. | Call the local Area Agency on Aging or PA Department of Aging. Ask for an OPTIONS assessment. |
| Services My Way or other self-directed services | Some people already approved for certain long-term services who want to direct workers or manage part of an approved service budget. | Ask the CHC plan or service coordinator if self-direction is allowed in the person’s service plan. |
What Medicaid home care may cover in Pennsylvania
Medicaid home care in Pennsylvania is not one single benefit. The right path depends on the person’s age, disability, income, assets, Medicare status, county, and level of care need.
There are three ideas to know first.
State plan services
These are regular Medical Assistance benefits. They may include doctor care, home health, medical supplies, and rides to covered medical care when rules are met. These benefits are not always enough for long-term daily help.
Waiver services
Waiver services are home and community-based services for people who meet a higher level of care need. They can include extra help meant to keep a person out of a nursing facility when possible.
Managed care route
CHC is the managed care route for many adults who need Medicaid long-term services and supports. A CHC plan and service coordinator help set up the approved service plan.
Services that may be part of a home care plan
The services below may be available through CHC, Medical Assistance long-term care, OPTIONS, LIFE, or another route. The exact services must be approved in the person’s plan. Ask for the approval in writing.
- Personal care: help with daily tasks the person cannot do safely alone.
- Bathing help: help with bathing, showering, washing, and safe bathroom transfers.
- Dressing help: help putting on clothes, shoes, braces, compression items, or other needed items.
- Homemaker help: help with household tasks tied to the person’s care needs, such as light cleaning, laundry, shopping, or meal tasks when approved.
- Meals: possible home-delivered meals or in-home meals through long-term care or aging services.
- Transportation: rides to Medicaid-covered medical care may be available through Medical Assistance transportation. Some long-term care plans may also approve other transportation tied to the service plan.
- Emergency response: a personal emergency response system may be covered when needed for safety.
- Respite: short-term help so an unpaid caregiver can step away for a limited time.
- Adult day care: Pennsylvania programs may call this Adult Day Services or Adult Daily Living Services.
Important: A doctor’s note helps explain the need, but it does not approve hours by itself. The person usually needs an application, an assessment, a financial review, and a written service plan.
Programs to check first
Community HealthChoices (CHC)
CHC is the main Medicaid managed care program to check for many Pennsylvania adults who need long-term help at home. It may apply when the person is age 21 or older and has both Medicare and Medicaid, or when the person needs Medicaid long-term services and supports because of help needed with everyday tasks.
CHC can include physical health services and long-term services and supports. A CHC participant may have a service coordinator who helps with the person’s care plan.
Ask about CHC if the person needs steady help with bathing, dressing, toileting, transfers, eating, cooking, housework, shopping, memory problems, or safety at home.
Medical Assistance long-term care and HCBS
HCBS means home and community-based services. These services are meant to help a person stay at home or in the community instead of moving into a long-term care facility.
In Pennsylvania, long-term care services include HCBS and facility care. If someone applies for Medical Assistance payment of long-term care, the state checks both care need and financial eligibility.
For a plain-English overview of waiver services, see Medicaid HCBS waivers explained.
LIFE
LIFE stands for Living Independence for the Elderly. It is Pennsylvania’s name for the national PACE model. It brings medical care and support services together through a LIFE provider.
LIFE may be an option for some people age 55 or older who meet care-need and financial rules, live in a LIFE service area, and can live safely in the community with LIFE services. The person may need to use the LIFE provider team for covered care.
If the person is 55 or older, ask PA IEB or a LIFE provider whether LIFE is open in the person’s ZIP code.
OPTIONS Program
OPTIONS is run through Pennsylvania’s aging network. It may help some adults age 60 or older with care management, adult day services, in-home meals, personal care, home support, emergency response, and other supports.
OPTIONS is not the same as Medicaid long-term care. It may still help while a Medicaid application is pending, when the person does not qualify for Medicaid long-term services, or when the family needs a local aging office to screen the situation.
If you need caregiver relief, also see respite care for caregivers.
Services My Way and family caregiver pay
Some Pennsylvania long-term service models allow participant direction. This can mean the person receiving services has more say over who provides care and when care is given.
Services My Way is a self-directed option tied to certain approved services. It does not mean every family member can be paid. Some relatives may not be allowed. The worker must meet program and plan rules.
Ask the service coordinator this exact question: “Can this participant hire a family member as a direct care worker under this service plan? Which relatives are allowed, and which are not?”
For more help, read Can I get paid to be a caregiver? and try the paid caregiver quiz.
Who may qualify
There is no single answer for every Pennsylvania household. Each route has its own rules. Most Medicaid home care decisions look at these areas.
Care needs
The person may need help with activities of daily living. These include bathing, dressing, eating, toileting, moving from bed to chair, and getting around safely.
Financial rules
Medical Assistance has income and resource rules. Long-term care rules can be different from basic Medicaid rules. Ask before moving money or giving away assets.
Age or disability route
CHC, LIFE, OPTIONS, and other programs use age, disability, Medicare status, Medicaid status, and level of care rules in different ways.
Many long-term service routes require the person to be found nursing-facility clinically eligible. This means the state or plan decides that the person needs a level of care similar to nursing facility care, even if the person wants to receive services at home.
If the person has too much income or assets for one Medicaid category, ask about other legal options before giving up. A Medicaid spend-down may be possible in some cases. Start with Medicaid spend-down and read about the Medicaid look-back period before moving assets.
How the assessment works
An assessment is a formal review of the person’s needs. It may happen at home, in a hospital, in a nursing facility, or through the route set by the program.
The assessor may ask about:
- medical conditions and recent hospital stays
- falls, wandering, memory problems, or unsafe cooking
- help needed with bathing, dressing, toileting, eating, and transfers
- help needed with meals, laundry, shopping, cleaning, and rides
- what unpaid caregivers already do
- whether the caregiver can keep doing that care
- home safety, stairs, bathroom access, and equipment needs
Be honest. Do not describe the best day. Describe a normal hard day and the worst safety risks.
If the person has dementia, stroke effects, Parkinson’s disease, serious weakness, falls, or unsafe behavior, say that clearly. Bring notes. If you help every day, explain what happens when you are not there.
Caregiver tip: Keep a simple care log for one week. Write down each task, how long it takes, and what happens if no one helps. This can support the assessment and any later appeal.
How to apply
Start based on the problem in front of you.
If the person needs long-term help at home
Call the PA Independent Enrollment Broker at 1-877-550-4227. Ask to apply for long-term services and supports at home. Ask whether CHC, LIFE, or another route fits.
If the person needs to apply for Medical Assistance
Apply online through COMPASS, call 1-866-550-4355, or contact the local County Assistance Office. Ask for Medical Assistance and long-term care if the person needs home or facility care.
If the person is age 60 or older and needs local aging help
Call the local Area Agency on Aging. Ask for OPTIONS, caregiver support, meal programs, transportation, and a home needs assessment.
Phone script
“Hi. I am helping my [mother/father/spouse/relative]. They live in Pennsylvania and need help at home with bathing, dressing, meals, transportation, and safety. I want to apply for Medicaid long-term services and supports at home. Can you tell me whether we should start with CHC, LIFE, a waiver, the County Assistance Office, or the Area Agency on Aging? I also need to know what forms and papers to gather.”
Documents to gather
- Medicaid, Medicare, Social Security, and insurance cards
- photo ID, Social Security number, and proof of Pennsylvania address
- doctor names, clinic names, and hospital discharge papers
- medicine list and diagnosis list
- proof of income, such as Social Security, pension, wages, or VA benefits
- bank statements, life insurance papers, retirement accounts, and other asset records if requested
- rent, mortgage, utility, and medical bills
- power of attorney, guardianship order, or health care representative papers if you have them
- care log showing daily help needed
- denial letters, cut letters, or plan notices if services were refused or reduced
For more help getting organized, use caregiver checklists. For more call wording, see phone scripts for caregivers.
What to do while waiting
Home care applications can take time. Do not wait without a plan.
- Ask if there is a waitlist or missing paperwork. Get the name of the person you spoke with and the next step.
- Ask the doctor about home health. If the person needs skilled nursing, therapy, wound care, or post-hospital care, ask the doctor whether a home health order is appropriate.
- Call the Area Agency on Aging. Ask about OPTIONS, meals, caregiver support, adult day services, transportation, and respite.
- Ask about transportation. If the person has Medical Assistance, ask about rides to Medicaid-covered medical care.
- Track care costs. Use a list or spreadsheet. You can also use the care cost calculator.
- Check other benefits. A veteran or surviving spouse may want to read about VA Aid and Attendance.
- Keep tax records. Some caregiving costs may matter at tax time. Start with caregiver tax deductions.
Safety note: If the person is not safe at home, tell the doctor, discharge planner, service coordinator, Area Agency on Aging, or PA IEB. Use words like “unsafe discharge,” “falls,” “wandering,” “no caregiver available,” or “cannot bathe or toilet safely.”
If services are denied or cut
A denial or cut is not always the final answer. Read the notice right away. Deadlines can be short.
The notice should explain what was denied, reduced, changed, or approved differently than requested. It should also explain how to ask for review, file a complaint or grievance, or ask for a fair hearing.
1. Ask for the reason in writing
Do not rely only on a phone call. Ask for the written notice, the rule used, and the deadline to respond.
2. Ask about continuing services
If current services are being reduced or stopped, ask how fast you must appeal to keep services during the review. The deadline may be shorter than the normal appeal deadline.
3. Gather proof
Use doctor letters, hospital records, fall records, care logs, photos of unsafe areas, and caregiver statements. Focus on daily care needs and safety.
4. Ask for a reassessment if needs changed
A hospital stay, fall, new diagnosis, caregiver loss, or new safety problem may support a new assessment.
If the first answer is no
Say: “Please send me the denial or reduction notice in writing. I need the appeal deadline, the reason for the decision, and the rule used. I also want to ask for a reassessment because the care needs are not being met.”
If you are already in CHC, call the CHC plan and ask for the grievance or complaint process. If you are applying, ask PA IEB or the County Assistance Office what appeal process applies to the denial.
FAQ
Is Pennsylvania Medicaid the same as Medical Assistance?
Yes. Pennsylvania often uses the name Medical Assistance for Medicaid.
Who should I call first for Medicaid home care in Pennsylvania?
For long-term help at home, call the PA Independent Enrollment Broker at 1-877-550-4227. If the person also needs to apply for Medical Assistance, use COMPASS, call 1-866-550-4355, or contact the County Assistance Office.
Does CHC pay for bathing and dressing help?
CHC may cover personal assistance services when the person qualifies and the service is approved in the plan. The assessment and service plan decide what is approved.
Can a family member get paid in Pennsylvania?
Maybe. Some self-directed models may allow certain family members to work as paid caregivers. The rules depend on the program, the relationship, the service plan, and the managed care plan. Ask before assuming a relative can be hired.
Does Medicare pay for long-term home care?
Medicare may cover limited home health care when its rules are met. It generally does not pay for long-term custodial care by itself, such as ongoing help with bathing, dressing, and meals when that is the only care needed.
What if my parent is over income for Medicaid?
Ask the County Assistance Office or a qualified elder law attorney before moving money or giving anything away. Spend-down and long-term care rules can be strict. The look-back period can cause problems if assets are transferred.
Can OPTIONS help if Medicaid is pending?
It may help some people age 60 or older, depending on need, local resources, and the Area Agency on Aging. Ask for an OPTIONS assessment and ask about any cost share.
Resumen en español
En Pensilvania, Medicaid se llama Medical Assistance. Si una persona necesita ayuda en casa con baño, ropa, comida, transporte o seguridad, llame al PA Independent Enrollment Broker al 1-877-550-4227 y pida ayuda para solicitar servicios de largo plazo en el hogar.
Si la persona tiene 60 años o más, también llame a la Area Agency on Aging local y pregunte por OPTIONS, comidas, transporte, cuidado diurno para adultos y descanso para cuidadores.
Official sources used
- Pennsylvania DHS: Apply for Community HealthChoices
- Pennsylvania DHS: Community HealthChoices
- Pennsylvania DHS: Home and Community-Based Services
- Pennsylvania DHS: Independent Enrollment Broker
- PA Independent Enrollment Broker
- Pennsylvania DHS: Apply for Long-Term Care Services
- Pennsylvania DHS: Apply for Benefits
- Pennsylvania Department of Aging: Apply for the OPTIONS Program
- Pennsylvania DHS: LIFE, Living Independence for the Elderly
- Pennsylvania DHS: Medicaid General Eligibility
- Pennsylvania DHS: CHC Supporting Documents
- Medicare.gov: Long-Term Care Coverage
About this guide
This guide was written for family caregivers who need a clear starting point. It focuses on Pennsylvania home care benefits, payment routes, applications, assessments, wait times, denials, and practical next steps.
Disclaimer
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state. Confirm current rules with official Pennsylvania sources before you act.
