How to pay for home care in Pennsylvania

We wrote this because we kept having the same fifteen-minute phone call. Nothing here is a sales pitch — some of these programs are ones you would use with a different agency, or without an agency at all.

1. Community HealthChoices (CHC)

Pennsylvania's Medicaid managed long-term care program. This is the largest single payer for in-home personal care in the state.

Who it is for: adults 21 and over who are eligible for Medicaid and need a nursing-facility level of care, along with people who have both Medicare and Medicaid.

What it covers: personal assistance services at home — bathing, dressing, mobility, meals, and related help — along with service coordination and other long-term supports.

How it works: you enroll in Medicaid first, then choose one of the CHC managed care plans. The plan assigns a service coordinator, and that coordinator authorizes hours and arranges the provider agency.

2. Act 150

A state-funded program, separate from Medicaid, that pays for attendant care.

Who it is for: Pennsylvanians between 18 and 59 with a physical disability who need help with daily activities but do not qualify for Medicaid.

The catch: there is income-based cost sharing, so it is not always free — but it is often far less than paying privately.

3. The OBRA Waiver

For adults 18 to 59 with a severe developmental physical disability who need an intermediate-care level of support. Narrower than the programs above, but worth asking about if a disability began early in life.

4. VA benefits for Veterans

This is the most frequently missed one. Families pay out of pocket for years without ever asking.

• Homemaker and Home Health Aide services — provided through VA Community Care. Pennsylvania is in the region administered by Optum.
• Veteran Directed Care — the Veteran receives a budget and directs their own services, including choosing who provides them.
• Aid and Attendance — an increase to the VA pension for Veterans or surviving spouses who need help with daily activities. It is paid in cash, so it can be used for home care.

Eligibility is determined by the VA, not by any agency. Start with the Veteran's VA primary care team or the social work department at their VA medical center.

5. Long-term care insurance

If there is a policy, this is usually the smoothest path there is — and the most commonly forgotten. Policies bought in the 1990s and 2000s are sitting unused in filing cabinets all over the Lehigh Valley.

Two things to check on the policy: the elimination period (a waiting period, often 30 to 90 days, that you generally have to pay through before benefits begin) and the daily or monthly benefit amount. Because of the elimination period, starting care sooner rather than later usually works in your favor.

We bill long-term care policies directly, so the family is not fronting money and chasing reimbursement.

6. Private pay

Straightforward hourly care with no program, no eligibility determination and no waiting. It is what most families use while a Medicaid or VA application is pending, and what many simply choose because it starts immediately.

What Medicare does not cover

Worth stating plainly, because it causes more confusion than anything else on this page. Medicare does not pay for ongoing personal or companion care at home. It covers short-term skilled care — a nurse or a physical therapist for a limited period after a hospitalization — and then it ends. Help with bathing, dressing, meals and supervision is not a Medicare benefit, no matter how much it is needed.

Where to start

If you are not sure which of these applies to your family, call us at 610-466-5715. Sorting it out takes about fifteen minutes, costs nothing, and we will tell you honestly if the answer is a program we cannot bill.

You can also contact your county Area Agency on Aging — Lehigh County Aging and Adult Services, Monroe County Area Agency on Aging, or Northampton County Area Agency on Aging — which handles assessments and referrals regardless of which agency you eventually use.