Pennsylvania Medicaid HCBS waivers
Last checked: May 18, 2026
If you care for someone in Pennsylvania who needs help at home, Medicaid home and community-based services may be one path to ask about. In Pennsylvania, Medicaid is often called Medical Assistance.
This guide explains the main waiver routes, where to start, what to ask for, and what to do if the first answer is no.
Quick answer
In Pennsylvania, the main Medicaid home care route for many older adults and adults with physical disabilities is Community HealthChoices, often called CHC. CHC can cover home and community-based services when the person meets medical and financial rules and the services are approved in a care plan.
Some people can use self-directed services, including Services My Way, to hire their own direct care worker. That may include some family members or trusted helpers, but it does not mean every family caregiver can be paid.
Pennsylvania warning before you apply
Rules can change. Counties, managed care plans, waiver contractors, and agencies may use different names for the same type of help. Always confirm your situation with official Pennsylvania sources, your CHC plan, the PA Independent Enrollment Broker, your County Assistance Office, your Area Agency on Aging, or your County Mental Health/Intellectual Disability office.
Start here
- For an older adult or adult with a physical disability: call the PA Independent Enrollment Broker at 1-877-550-4227. Ask for the Medicaid long-term services and supports process for home and community-based services. TTY users can call 1-877-824-9346.
- For a person age 60 or older: call your local Area Agency on Aging or PA Link and ask about OPTIONS, caregiver support, meals, transportation, and help while Medicaid is being reviewed.
- For intellectual disability, developmental disability, or autism: call the local County Mental Health/Intellectual Disability office. Ask about ODP waiver eligibility, PUNS, and waiver waiting lists.
Main programs and where to start
This table is a routing tool. It is not a full eligibility test.
| Program or route | Who it may help | Where to start |
|---|---|---|
| Community HealthChoices (CHC) | Adults 21 or older who have both Medicare and Medicaid, or adults who need Medicaid long-term services and supports because of daily care needs. | Call the PA Independent Enrollment Broker. Also work with the County Assistance Office for financial Medical Assistance rules. |
| OBRA Waiver | Pennsylvania residents age 18 through 59 with a severe developmental physical disability who meet the required level of care. People who turn 60 while enrolled may stay if services are still needed. | Ask the PA Independent Enrollment Broker or DHS Office of Long-Term Living about OBRA screening. |
| ODP waivers: Consolidated, Community Living, and Person/Family Directed Support | People with intellectual disability, developmental disability, or autism who meet Office of Developmental Programs rules. | Call the local County Mental Health/Intellectual Disability office. Ask for ODP waiver intake and PUNS. |
| Adult Autism Waiver | Medicaid-enrolled adults with autism spectrum disorder who need long-term services and supports. | Call the local County Mental Health/Intellectual Disability office and ask how to apply. |
| OPTIONS Program | Pennsylvania residents age 60 or older who need help staying at home. This is not a Medicaid waiver. | Contact the local Area Agency on Aging. |
| Caregiver Support Program | Some unpaid caregivers who have primary care duties for an eligible person. | Contact the local Area Agency on Aging. |
| LIFE program | Some people age 55 or older who meet level of care and live in a LIFE service area. This may be an option instead of CHC. | Ask the PA Independent Enrollment Broker, County Assistance Office, or local aging office whether LIFE is available where the person lives. |
What an HCBS waiver is
HCBS means home and community-based services. It is Medicaid help that may pay for care in a person’s home or community instead of a nursing facility or other institution.
The word “waiver” means the federal government lets a state use Medicaid funds in a different way. The state still has rules. The person usually must meet financial rules and care-need rules.
An HCBS waiver is not a cash grant. It does not pay a family just because care is hard. It pays for approved services in an approved care plan.
For a deeper plain-English guide, see Medicaid HCBS waivers explained.
Main waivers in Pennsylvania
Community HealthChoices (CHC)
CHC is Pennsylvania’s Medicaid managed long-term services and supports program for many older adults and adults with physical disabilities. CHC uses managed care plans to coordinate Medicaid physical health services and long-term services and supports.
Many caregivers hear older names such as Aging Waiver, Attendant Care Waiver, CommCare, or Independence Waiver. If someone uses one of those names, ask whether they mean CHC today.
CHC is often the first route to ask about when the person is 21 or older and needs hands-on help with daily tasks, such as bathing, dressing, toileting, eating, transfers, or safety supervision.
OBRA Waiver
The OBRA Waiver is for certain Pennsylvania residents age 18 through 59 who have a severe developmental physical disability and meet the required level of care. Pennsylvania’s DHS says new applicants age 60 or older are referred to other programs.
If your loved one has a physical disability that began earlier in life and is not mainly an aging issue, ask about OBRA. Do not guess. Ask the PA Independent Enrollment Broker or DHS Office of Long-Term Living which route fits.
ODP waivers for intellectual disability, developmental disability, and autism
Pennsylvania’s Office of Developmental Programs, called ODP, runs waiver services for people with intellectual disability and autism. The main ODP waivers include the Consolidated Waiver, Community Living Waiver, Person/Family Directed Support Waiver, and Adult Autism Waiver.
For these routes, the starting point is usually the local County Mental Health/Intellectual Disability office. Ask for waiver intake, eligibility review, supports coordination, and PUNS.
OPTIONS and Caregiver Support are not the same as Medicaid waivers
The OPTIONS Program and the Pennsylvania Caregiver Support Program may still matter. They can help some households with aging services, respite, supplies, counseling, and other supports.
These programs do not replace Medicaid HCBS. They can be useful while you wait, if Medicaid is denied, or if the person does not need a nursing facility level of care.
Services that may help caregivers
Services depend on the waiver, the person’s assessed needs, the care plan, provider access, and program rules. Ask for the service by need, not only by name.
For example, say, “She cannot bathe safely without hands-on help,” or “He cannot be left alone while I work.” This helps the assessor understand the real care problem.
Personal care or personal assistance
This may help with bathing, dressing, eating, toileting, transfers, mobility, and other daily tasks. In CHC, this is often called personal assistance services.
Respite
Respite gives the main caregiver a break when the service is approved. It may be planned or may help during a short-term need. Learn more at respite care for caregivers.
Adult day or adult daily living
This may give the person supervision and help during the day. It can also give the caregiver time for work, rest, or other duties.
Home changes and equipment
Some waivers may cover approved home adaptations, assistive technology, medical supplies, or equipment when tied to the person’s needs and plan.
Transportation
Transportation rules vary. Medical rides, non-medical rides, and stretcher transportation may go through different programs or the CHC plan.
Caregiver supports
Support may include training, service coordination, a backup plan, and help finding other services. The exact help depends on the route and the care plan.
Tip: Before an assessment, write down the help needed on a bad day. Include falls, wandering, missed medicine, incontinence, unsafe cooking, transfers, and nighttime care. Use caregiver checklists to prepare.
Can family caregivers be paid through a waiver?
Sometimes. Pennsylvania has self-directed options in some long-term services programs. This means the person receiving services, or an approved representative, may have more say in who provides approved care.
For older adults and adults with physical disabilities, ask about participant direction, the Consumer-Employer Model, personal assistance services, and Services My Way. These options may let the person hire and manage direct care workers instead of using only an agency worker.
In real life, a direct care worker may be a trusted person the participant knows. That can include some relatives when all rules are met. But some people, such as spouses, legal guardians, powers of attorney, or other legally responsible people, may have special limits. Ask the CHC plan, service coordinator, and fiscal/employer agent before you make plans around pay.
Do not quit a job based on a phone rumor. A family caregiver is not paid until the person is approved, the service is authorized, the worker is allowed, hiring paperwork is done, background checks are complete, and hours are approved.
What to ask for
- “Can this care plan include personal assistance services?”
- “Can these services be self-directed?”
- “Is Services My Way available for this person?”
- “Can the family member I named be hired as the direct care worker?”
- “Are spouses, guardians, representatives, or powers of attorney allowed in this case?”
- “Who handles payroll, timesheets, taxes, and worker forms?”
For more help, see Can I get paid to be a caregiver? and the paid caregiver quiz.
Waitlists and priority
Waitlists do not work the same for every Pennsylvania route.
CHC and OLTL routes
For CHC and other Office of Long-Term Living routes, the person must go through the application, assessment, and financial review steps. Delays can happen because of paperwork, medical records, financial proof, plan review, or provider shortages.
Ask who has the file, what step is next, and whether anything is missing. If services are denied, reduced, or delayed, ask for a written notice and appeal rights.
ODP waivers and PUNS
For intellectual disability and autism waivers, Pennsylvania uses PUNS, which stands for Prioritization of Urgency of Need for Services. PUNS helps record who is waiting for Medicaid HCBS funding and how urgent the need is when there is a waiting list.
Official Pennsylvania pages say ODP waivers have a limited number of people who can be served and that priority goes to people with the most emergent needs. If needs get worse, ask the county to update PUNS.
OPTIONS and caregiver programs
Non-Medicaid aging programs may depend on local funds and local rules. Ask the Area Agency on Aging if there is a waiting list, what can start now, and what proof is needed.
How to apply
Step 1: Pick the right first call
For most older adults and adults with physical disabilities, start with the PA Independent Enrollment Broker at 1-877-550-4227. Ask for long-term services and supports in the home.
For people age 60 or older, also call the local Area Agency on Aging. Ask about OPTIONS, Caregiver Support Program, meals, transportation, and respite.
For intellectual disability, developmental disability, or autism, call the County Mental Health/Intellectual Disability office. Ask for ODP eligibility and waiver intake.
Step 2: Ask for the correct assessment
Do not only say, “We need help.” Be specific. Ask for a Medicaid long-term services and supports assessment for home and community-based services.
Say what the person cannot do alone. Include bathing, dressing, toileting, transfers, meal prep, medicine reminders, memory problems, falls, unsafe behavior, and overnight needs.
Step 3: Complete the financial review
The County Assistance Office reviews Medical Assistance financial rules. You may need proof of income, bank accounts, resources, insurance, and household facts.
If income or resources are too high, ask whether any Medical Assistance spend-down, long-term care budgeting, or other rule may apply. Start with Medicaid spend-down and Medicaid look-back period for plain-English background.
Step 4: Review the care plan before you agree
If approved, the care plan should match the person’s real needs. Ask how many hours are approved, what services are included, who provides them, and what to do when a worker misses a shift.
If you want a family member to be a paid worker, ask about self-direction before the plan is final.
Phone script
“Hi, I care for my [mother/father/spouse/relative] in Pennsylvania. They need help with [bathing, dressing, toileting, transfers, meals, medicine, memory, safety]. I want to ask for Medicaid long-term services and supports at home. Can you tell me whether we should start with Community HealthChoices, OBRA, ODP, OPTIONS, or another program?”
“Also, please tell me what papers you need, who will do the assessment, and how we can ask about self-directed services or a family caregiver as a direct care worker.”
Documents to gather
- Photo ID and proof of Pennsylvania address
- Social Security number
- Medicare, Medicaid, and other insurance cards
- Proof of income, such as Social Security, pension, wages, or VA benefits
- Bank and resource records requested by the County Assistance Office
- Doctor names, diagnoses, medicine list, and recent discharge papers
- List of daily tasks the person cannot do alone
- Power of attorney, guardianship papers, or representative forms, if any
- Rent, mortgage, utility, and care cost information
To compare care costs while you wait, use the care cost calculator. For call prep, use phone scripts.
If denied or waitlisted
A denial is not the same as the end of the road. It may mean the agency says the person does not meet financial rules, does not meet care-need rules, did not send proof, or asked the wrong office.
If the first answer is no
Ask, “What program would fit this person better?” Then ask for the exact office name, phone number, and next form. If the person is unsafe at home, say that clearly and ask for urgent review.
If you think the person is being abused, neglected, or financially exploited, report it. Pennsylvania’s elder abuse helpline is 1-800-490-8505. If there is immediate danger, call 911.
For veterans or surviving spouses, also check VA Aid and Attendance. For tax questions, see caregiver tax deductions.
FAQ
Is Pennsylvania Medicaid the same as Medical Assistance?
Yes. Pennsylvania often uses the name Medical Assistance for Medicaid.
Does CHC pay the family caregiver directly?
Not like a simple cash benefit. If self-directed care is approved, the direct care worker must be allowed, hired, and paid through the required payroll process. Hours must be approved in the care plan.
Can a spouse be paid to provide care?
Do not assume yes. Spouses and other legally responsible people may have special limits. Ask the CHC plan, service coordinator, and fiscal/employer agent for the current rule in writing.
Is there one Pennsylvania waiver for all caregivers?
No. The right route depends on age, disability, care needs, Medicaid status, county office, and waiver type.
Is the OPTIONS Program a Medicaid waiver?
No. OPTIONS is an aging program for Pennsylvania residents age 60 or older. It may still help with in-home support and local services.
What if my loved one is in the hospital or nursing facility?
Ask the discharge planner or social worker to help start the Medicaid long-term services process. Ask about CHC, LIFE, nursing home transition, and what is needed for a safe return home.
Resumen breve en español
En Pennsylvania, muchos servicios de Medicaid para cuidado en casa pasan por Community HealthChoices, llamado CHC. La persona debe cumplir con reglas médicas y financieras.
Llame al PA Independent Enrollment Broker al 1-877-550-4227 si la persona necesita ayuda en casa. Si la persona tiene discapacidad intelectual, discapacidad del desarrollo o autismo, llame a la oficina local de Mental Health/Intellectual Disability del condado.
Pregunte si hay servicios autodirigidos y si un familiar puede ser trabajador pagado. No asuma que todos los familiares pueden recibir pago.
About this guide
This guide was written for family caregivers who need a practical first step. It focuses on Pennsylvania benefit routes, waiver services, caregiver payment questions, waitlists, applications, and appeals.
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.
Official sources used
- Pennsylvania Department of Human Services: Home and Community-Based Services
- Pennsylvania Department of Human Services: Medicaid Waivers
- Pennsylvania Department of Human Services: Community HealthChoices
- Pennsylvania Department of Human Services: Apply for Community HealthChoices
- Pennsylvania Department of Human Services: Apply for Long-Term Care Services
- Pennsylvania Department of Human Services: CHC Contact Information
- Pennsylvania Department of Human Services: OBRA Waiver
- Pennsylvania Department of Human Services: Consumer Directed Services
- Pennsylvania Department of Human Services: Apply for a Medicaid Consolidated Waiver
- Pennsylvania Department of Human Services: Request a Medicaid Community Living Waiver
- Pennsylvania Department of Human Services: Apply for the Medicaid Person/Family Directed Support Waiver
- Pennsylvania Department of Human Services: Apply for the Medicaid Adult Autism Waiver
- Pennsylvania Department of Human Services: PUNS
- Pennsylvania Department of Human Services: Hearings and Appeals
- Pennsylvania Department of Aging: PA Link to Aging and Disability Resources
- Pennsylvania Department of Aging: Area Agencies on Aging
- Pennsylvania Department of Aging: Apply for the OPTIONS Program
- Pennsylvania Department of Aging: Apply for the Caregiver Support Program
- Pennsylvania Department of Aging: Report Elder Abuse
- Medicaid.gov: Home and Community-Based Services 1915(c)
