CHC Program members can choose from a variety of plans, and they can self-direct some of their long term care benefits using Pennsylvania’s “Services My Way” option. Pennsylvania uses its Functional Eligibility Determination (FED) tool to evaluate CHC Program applicants and decide which benefits they needed and the state will provide.ĬHC Program participants receive their medical care and non-medical personal services through a single Medicaid plan provided by a managed care organization (MCO), which has a network of care providers. While the CHC Program will but it will not pay for room and board in any of these settings.ĬHC Program benefits include adult day care, home modifications, meal delivery, transportation, medication management and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Pennsylvania’s Community HealthChoices (CHC) Program, formerly known as the Department of Aging Waiver, provides long term care services and supports to Pennsylvania Medicaid recipients who require a Nursing Facility Level of Care but live in their own home, the home of a loved one, a personal care home, an adult foster care home or an assisted living residence. Pennsylvania residents can receive HCBS Waiver long term care benefits through the state’s Community HealthChoices Program. Once those spots are full, additional eligible applicants will be placed on a waiting list. Instead, there are a limited number of enrollment spots. So, even if an applicant is eligible for an HCBS Waiver program in Pennsylvania, they are not guaranteed by law to receive the benefits. Remember, entitlement means guaranteed by law. Unlike Nursing Home Medicaid, Pennsylvania HCBS Waivers are not an entitlement. Think of it as a voucher that will pay for long term care services for Pennsylvania residents who live in their own home, the home of a loved one, a personal care home, an adult foster care home or an assisted living residence. The word “waiver” means something like voucher in this instance. Home and Community Based Service (HCBS) Waivers will pay for long term care services and supports that help Pennsylvania Medicaid recipients who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. Home and Community Based Service (HCBS) Waivers MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. This help can include paying for moving expenses, as well as long term care services and supports in the new residence. This can be spent on personal items such as clothes, snacks, books, etc.Ī Nursing Home Alternative – Pennsylvania Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Pennsylvania’s Money Follows the Person program (MFP). They are only allowed to keep a “personal needs allowance” of $45 / month, as of 2023. This means that eligible Pennsylvania residents who apply are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved.Īny Pennsylvania Medicaid beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. Some of the things that Pennsylvania Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with Activities of Daily Living (mobility, bathing, dressing, eating, toileting). This includes payment for room and board, as well as all necessary medical and non-medical goods and services. Pennsylvania Medicaid will cover the cost of long term care in a nursing home for eligible Pennsylvania residents through its Nursing Home / Institutional Medicaid. Pennsylvania Medicaid Long Term Care Programs Nursing Home / Institutional Medicaid Table of Contents Last Updated: Pennsylvania Medicaid Long Term Care Programs Nursing Home Care via Institutional Medicaid Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid Applying Choosing a Nursing Home
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