Does Medicaid Cover Home Care in Pennsylvania?

Yes. Pennsylvania Medicaid, officially called Medical Assistance, does cover home care in Pennsylvania. Most adults receive it through Community HealthChoices (CHC), a statewide managed care program that pays for personal assistance, home health, therapies, equipment, and home modifications so eligible residents can stay out of nursing facilities. Smaller waivers and the LIFE program cover specific populations alongside CHC.¹

What Home Care Services Medicaid Actually Pays For

Under the CHC waiver, Personal Assistance Services cover hands-on help with bathing, dressing, grooming, meal preparation, medication management, light housekeeping, laundry, and mobility assistance inside and outside the home. These are the most commonly used services and the ones that keep most participants out of a facility.²

CHC also pays for home health aide services, nursing, and physical, occupational, speech, and cognitive rehabilitation therapy delivered at home.³

Beyond people, Medicaid covers the things that make a home workable: adaptations such as widened doorways and bathroom modifications, specialized medical equipment and supplies, personal emergency response systems, assistive technology, respite care, non-medical transportation, and vehicle modifications capped at $5,000. For someone leaving a nursing facility or other institution, community transition services can pay up to $4,000 (lifetime) in one-time move-in costs.³

Once someone is enrolled, a service coordinator from their chosen managed care organization (AmeriHealth Caritas, PA Health & Wellness, or UPMC) builds a Person-Centered Service Plan that spells out exactly which services they receive and how many hours.³

Who Qualifies for Home Care Through Medicaid

Qualifying has two separate parts: a clinical test and a financial test. You must pass both.

Clinical Eligibility: Nursing Facility Level of Care

To receive home and community-based waiver services, you have to be found “Nursing Facility Clinically Eligible.” That means an assessor concludes you need the level of care a nursing home would provide, even though you will actually receive it at home. The evaluation looks at cognition, how much help you need with activities of daily living (bathing, dressing, toileting, eating, personal hygiene, walking, and medication management), behavioral issues such as wandering, and bowel incontinence. A physician also has to certify that you meet the standard.⁴

For CHC applicants in the community, the clinical assessment is handled by Maximus, a private independent enrollment broker. Reassessments happen at least once a year, and additional ones can be triggered by a hospitalization or a change in condition.⁵⁴

Financial Eligibility: Income and Assets

For 2026, a single applicant’s income cannot exceed $2,982 per month, and countable assets are limited to $8,000 (technically a $2,000 limit with a $6,000 disregard). A primary home, one car, and certain burial funds don’t count toward the asset total.⁶⁷

Married couples get important protections when only one spouse needs care. The non-applicant (community) spouse can keep up to $162,660 in countable assets and receive a monthly maintenance allowance of up to $4,066.50 from the applicant spouse’s income.⁶

Pennsylvania applies a five-year look-back. When you apply, the Department of Human Services reviews 60 months of financial transactions. Transfers for less than fair market value during that window trigger a penalty period of ineligibility. The 2026 penalty divisor is $421.20 per day, so a $15,000 gift would produce roughly a three-month ineligibility period.⁷⁶

How to Apply

You can apply for Medical Assistance four ways:

Online through the COMPASS portal at compass.dhs.pa.gov.
By phone to the Consumer Service Center at 1-866-550-4355.
In person at your local County Assistance Office.
By mail, using the paper application from the Department of Human Services website, sent to your County Assistance Office.⁸

Have proof of identity, Social Security numbers, income documents (wages, Social Security, pensions), bank and resource information, and details on any current health insurance or medical conditions ready. Married applicants also complete a Resource Assessment Form listing all assets as of the date the ill spouse first entered care.⁸⁹

The clinical assessment runs in parallel with the financial application. For the CHC waiver, the Pennsylvania Independent Enrollment Broker (1-877-550-4227) coordinates the clinical piece and helps you pick a managed care organization. You can track your application at trackmybenefits.pa.gov.¹⁰⁸

Can You Pay a Family Member to Provide the Care?

Often yes. Through the Services My Way option within the CHC waiver, participants self-direct their care: they recruit, hire, train, and supervise their own direct care workers using a budget built from their authorized service hours. Friends, neighbors, and most relatives can be hired this way.¹¹

The exclusions matter. The CHC waiver will not pay for services provided by a spouse, legal guardian, representative payee, or anyone holding power of attorney for the participant.¹¹ Pennsylvania also runs the OPTIONS program, a non-Medicaid alternative that allows certain family members to be paid, with fewer documented restrictions.¹²

Other Pennsylvania Programs That Cover Home Care

CHC is the main door for adults, but it is not the only one, and a person can only be enrolled in one waiver at a time.¹³

LIFE, Pennsylvania’s version of the national PACE model, is available at age 55 and older. It bundles skilled nursing, personal care, therapies, meals, transportation, day center activities, home modifications, and medical care into one managed program. Most dually eligible participants pay nothing out of pocket, and people can switch between LIFE and CHC at any time (transitions typically take one to two months).¹⁴¹³
The OBRA waiver serves adults 18 to 59 with severe developmental physical disabilities that began before age 22 and cause substantial limitations in at least three areas of daily functioning. It covers personal assistance, nursing, therapies, home adaptations, assistive technology, respite, and employment supports.¹⁰
The Community Living, Consolidated, and Person/Family-Directed Support waivers serve people with intellectual or developmental disabilities and include shift nursing, therapies, and residential habilitation.¹⁵
Act 150 is a state-funded attendant care program that is not technically a Medicaid waiver. It can help people who need personal assistance but don’t meet full Medicaid financial requirements.¹⁵

One structural point worth knowing: unlike nursing home Medicaid, which states must provide, home and community-based waiver programs are optional under federal law. That means these programs can carry enrollment caps and waiting lists.⁷

If Your Services Are Denied, Cut, or Terminated

Managed care organizations can reduce or end services, and participants have appeal rights with tight deadlines. The first step is a grievance with the MCO, filed within 60 days of the denial notice.¹⁶

The deadline that actually matters for most people is 10 days. If you file the grievance within 10 days of the notice date, your current level of services continues while the appeal is pending.¹⁷

If the MCO upholds its decision, you can escalate to an external review by an independent physician (within 15 days of the grievance decision) and request a fair hearing before an administrative law judge at the Department of Human Services’ Bureau of Hearings and Appeals (within 120 days). To keep services running through those secondary steps, file both the external review and the fair hearing within 10 days of the grievance decision letter.¹⁷ The Pennsylvania Health Law Project offers free help with appeals at 1-800-274-3258.¹⁶

Estate Recovery: Something to Understand Before You Enroll

Pennsylvania’s Medicaid Estate Recovery Program applies to people who received home and community-based services, not just nursing home residents. After a recipient who was 55 or older dies, the state can seek reimbursement from their estate for the cost of HCBS and related hospital and prescription drug services provided during that time.¹⁸

You do not have to sign over your home to receive services, and the state will not try to take the home while you are alive.¹⁹ If the home is held as tenancy by the entireties or joint tenancy with right of survivorship, a surviving spouse inherits it free of any Medicaid claim.²⁰ The state permanently waives its claim when the gross estate is $2,400 or less, and hardship waivers are available for family members who lived in the home and provided care there for at least two years during the time the recipient received services.

1
Pennsylvania Department of Human Services. Community HealthChoices
2
Pennsylvania Homecare Association. Understanding the CHC Waiver Personal Assistance Services in Pennsylvania
3
Disability Rights Pennsylvania. Services Available Through the CHC HCBS Waiver
4
Pennsylvania Health Law Project. CHC Waiver Terminations Based on Clinical Eligibility
5
Law VP. What It Means to Need Nursing Home Level of Care for Medicaid Eligibility
6
Pennsylvania Elder Law Network. Pennsylvania Medicaid Numbers and Elder Law Statistics
7
Medicaid Planning Assistance. Medicaid Eligibility Pennsylvania
8
Pennsylvania Department of Human Services. Apply for Medicaid Benefits
9
Elder Law of Pittsburgh. Medicaid Application Process in Pennsylvania
10
Pennsylvania Department of Human Services. OBRA Waiver
11
Tempus Unlimited. Services My Way Manual
12
Caregiver.org. Services by State – Pennsylvania
13
Pennsylvania Health Law Project. DHS Announces New LIFE Enrollment Process
14
PA LIFE Programs. About LIFE
15
Pennsylvania Department of Human Services. Home Community-Based Services
16
Disability Rights Pennsylvania. Challenging Eligibility and Service Decisions Under CHC HCBS Waiver
17
Pennsylvania Health Law Project. Is a CHC Plan Taking Away Services – Appeal
18
Pennsylvania Department of Human Services. Estate Recovery
19
Pennsylvania Department of Human Services. Estate Recovery Program Brochure
20
Community Legal Services of Philadelphia. Estate Recovery Program