You qualify for Pennsylvania Community HealthChoices eligibility if you are at least 21 years old and fall into one of two groups: adults who receive both Medicare and full Medicaid benefits, or adults who need nursing-facility-level care through Medicaid, whether that care is delivered in a facility or in your own home.1Department of Human Services. Community HealthChoices (CHC) You also have to meet Medicaid’s financial rules on income and countable assets. Community HealthChoices (CHC) is Pennsylvania’s mandatory Medicaid managed care program for this population, run by the Department of Human Services, and it replaces fee-for-service Medicaid for most people who qualify.
The Two Qualifying Groups
The first pathway is dual eligibility. If you are 21 or older and already receive both Medicare and full Medicaid, you are in CHC’s eligible population.1Department of Human Services. Community HealthChoices (CHC) This is the largest group CHC serves, and no separate clinical determination is required beyond what you already went through to establish Medicaid.
The second pathway is clinical need. You qualify if a Medicaid assessment finds that you need the level of care typically provided in a nursing facility. You do not have to live in a nursing home to meet this bar. Many people who qualify this way live at home and use CHC to pay for the help that keeps them there.1Department of Human Services. Community HealthChoices (CHC)
Participants already enrolled in certain home and community-based waivers are automatically part of CHC. That includes the Attendant Care, Independence, COMMCARE, and Aging waivers, along with OBRA waiver participants who have been found clinically eligible for nursing-facility care. Act 150 participants who also have dual Medicare and Medicaid coverage are included as well.1Department of Human Services. Community HealthChoices (CHC)
What the Clinical Assessment Looks For
If you are applying based on clinical need rather than dual eligibility, a trained assessor uses a standardized tool to measure how much help you need with daily activities: bathing, dressing, eating, moving around, managing medications. The question the assessor is answering is whether your functional limitations are severe enough that you would ordinarily need nursing-home placement. Reaching that threshold is what qualifies you, regardless of where you actually live.
The Pennsylvania Independent Enrollment Broker (PA IEB) coordinates this part of the process. You can reach the PA IEB at 1-877-550-4227 (TTY: 1-877-824-9346).2Department of Human Services. Independent Enrollment Broker Medical records and a physician’s certification describing your functional limitations help support the determination.
Income and Asset Limits
Financial eligibility turns on two numbers: your monthly income and your countable resources.
For 2026, your gross monthly income generally cannot exceed 300 percent of the federal Supplemental Security Income (SSI) benefit rate. The 2026 SSI rate for an individual is $994 per month, which puts the CHC income ceiling at $2,982.3Social Security Administration. SSI Federal Payment Amounts Income counts in the broad sense: Social Security, pensions, veteran’s benefits, and other recurring money.
The resource limit depends on which side of that income line you fall on. If your income is at or below 300 percent of the SSI rate, the base resource limit is $2,000 with an additional $6,000 disregard, so you can hold up to $8,000 in countable assets. If your income exceeds that threshold, the resource limit drops to $2,400.4Department of Human Services. Medicaid and Payment of Long-Term Services
Countable assets include bank accounts, investments, and the cash value of life insurance policies. Your primary home, one vehicle, and certain personal belongings are generally excluded.
Pennsylvania applies spousal impoverishment protections when only one member of a married couple is applying. The non-applying spouse is allowed to keep a share of the couple’s combined assets and a minimum level of monthly income. These figures adjust annually, so confirm the current numbers with your County Assistance Office before you apply.
How to Apply
Eligibility is not confirmed until both the financial side and the clinical side are complete. You can start them in either order, but neither alone enrolls you.
The Financial Application
The form is the PA 600L, the Medical Assistance Financial Eligibility Application for Long Term Care, Supports and Services.5Pennsylvania Department of Human Services. PA 600L Application You can file it online through the COMPASS portal, mail it to your County Assistance Office, or complete it by phone with a state representative.6Pennsylvania Department of Human Services. COMPASS
Documentation is extensive. Plan to produce Social Security numbers for everyone in your household, proof of every income source (Social Security statements, pension letters, veterans’ benefits records), and bank statements going back 60 months. That five-year window exists because the state checks whether assets were transferred, sold, or given away in ways that affect eligibility.7Department of Human Services. Medicaid and Payment of Long-Term Services – Section: Transfer of Assets You also need current valuations for life insurance, stocks, bonds, and certificates of deposit. Inconsistencies between what you report and what federal records show will slow the case down.
The Clinical Side
Contact the PA IEB to schedule the functional assessment described above. If you are applying through dual eligibility, your Medicaid status already does this work and you can move straight to plan selection once your file is in order.
A Boundary Worth Knowing Before You Apply
Qualifying for CHC long-term services carries a trade-off that many applicants and their families only learn about after the fact. Federal law requires Pennsylvania to seek reimbursement from the estate of anyone who was 55 or older when they received long-term care services, including nursing facility care and home and community-based services.8Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments, and Recoveries Pennsylvania’s Estate Recovery Program applies to Medicaid payments made on or after August 15, 1994.9Department of Human Services. Estate Recovery
Recovery happens after death and reaches only assets that pass through probate. The state cannot pursue recovery while a surviving spouse is alive, or if a surviving child is under 21, blind, or disabled.8Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments, and Recoveries A sibling with an ownership interest in the home who lived there for at least a year before the recipient entered a facility is also protected, as is an adult child who lived in the home for at least two years before institutionalization and provided care that helped delay admission.
Separately, if you enter a nursing facility and the state determines you are unlikely to return home, Pennsylvania can place a lien on your home while you are still alive. You are entitled to a hearing before that determination, and the lien dissolves if you are discharged and go home. No lien can attach if your spouse, a child under 21, a blind or disabled child, or a qualifying sibling currently lives there.10ASPE. Medicaid Liens None of this disqualifies anyone from CHC, but it is the kind of thing worth understanding before you sign the paperwork, especially if keeping a family home across generations matters to you.
Next Steps If You Think You Qualify
Call the PA IEB at 1-877-550-4227 to start the clinical assessment, and open a financial case either online through COMPASS or through your County Assistance Office. If you are already dually eligible for Medicare and Medicaid and you are 21 or older, you are in the eligible population now; your CHC enrollment is a matter of plan selection rather than fresh qualification. If you are applying based on clinical need, both the functional assessment and the financial determination have to come back favorable before enrollment moves forward.