Program Description
The Pennsylvania Community HealthChoices (CHC) program is a Medicaid managed care program for persons who are 21 years of age or older and are eligible for both Medicaid (known as Medicaid Assistance in Pennsylvania) and Medicare (the federal health insurance program) or those who require a nursing home level of care. While this program is not strictly for the elderly, it is very relevant for seniors, as many are dually eligible for Medicaid and Medicare and / or require a level of care consistent with that provided by a nursing home.
CHC provides seniors and physically disabled individuals with medical benefits, as well as long-term support services, to promote independent living and prevent unnecessary nursing home placement. Benefits include personal care services, such as assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADL), like bathing, meal preparation, and medication management. Enrollment in this program is mandatory for those who meet the eligibility requirements.
CHC is a relatively new program that rolled out in three phases (geographic regions) over a three-year period. The last phase rolled out in January 2020, which means CHC is now available statewide. Individuals who were receiving services via the Pennsylvania Department of Aging Medicaid Waiver were automatically enrolled in CHC as it became available in their area.
Eligibility Guidelines
General Requirements
In order to be eligible for Community HealthChoices, one must be 21 years of age or older and a resident of Pennsylvania. Applicants must also require a nursing home level of care or be eligible for both Medicaid and Medicare.
Financial Requirements
In order to be eligible for Medicaid, there are both income and asset limits.
Income Limits
For the state of Pennsylvania, as a general rule of thumb, seniors must have income no greater than 300% of the Federal Benefit Rate (FBR). As of 2024, this means a single elderly individual cannot have income in excess of $2,829 / month.
Asset Limits
The asset limit for a single senior is $2,000, although the state of Pennsylvania allows an additional $6,000 to be disregarded, allowing a total asset limit of $8,000. In addition, certain exemptions are allowed, such as one’s home, given the individual lives in the home, or intends to return to the home, and the equity value is under $713,000, household items, and personal effects.
Over the Financial Limits?
An option for persons over these limits is to work with a Medicaid planner, who can help families to gain Medicaid eligibility for their loved one. Read more about Medicaid planning here.
Benefits and Services
A wide variety of services, including long-term care benefits, are covered via this program, and may include the following:
- Adult Daily Living Services / Adult Day Health
- Assistive Technology / Durable Medical Equipment
- Medical Supplies
- Home Health Aide / Nursing
- Therapies (Physical, Occupational, Language, and Speech)
- Meal Delivery / Nutritional Counseling / Food Supplements
- Respite Care
- Non-Medical Transportation
- Personal Emergency Response Systems
- Home / Vehicle Modifications
- Nursing Home Care
- Hospice Care
- Medical / Dental Services
- Emergency Room Services
- Prescription Drugs
- Personal Assistance Services
- Counseling
- Service Coordination
- TeleCare
- Behavior Therapy
- Cognitive Rehabilitation Therapy
- Community Integration / Community Transition
- Pest Control
- Consumer Direction of Goods / Services (available via Services My Way)
*Please note, eligible applicants who are on Medicare will continue to receive all of the same services as before.
How to Apply / Learn More
Applying for HCH is a multi-step process.
- The applicant calls the PA Independent Enrollment Broker (PA IEB) at 877-550-4227.
- PA IEB requests a completed physician’s certification form from the applicant’s doctor.
- PA IEB conducts their first in-home visit with the applicant.
- Second in-home visit.
- The PA IEB reviews both the assessments from the in-home visits and the physician’s certification form. If the applicant meets the eligibility requirements, the application is forwarded on to the County Assistance Office (CAO).
- The CAO reviews the application for financial eligibility and provides a final decision within 90 days.
More information about CHC can be found here.
