Pennsylvania Community HealthChoices Program

Eligibility Requirements for Community HealthChoices in Pennsylvania

To qualify for CHC, applicants must meet several criteria. Here is a detailed breakdown of the eligibility requirements:

• Age: Applicants must be 21 years or older.
• Residency: Must be a resident of Pennsylvania.
• Citizenship: U.S. citizenship or qualified immigrant status is required.
• Medical Necessity: Individuals must have a physical disability or chronic health condition that requires assistance with everyday activities, known as Activities of Daily Living (ADLs).
• Medicaid and Medicare: Eligible participants must either be dually enrolled in both Medicaid and Medicare or qualify for long-term support through Medicaid.
• Functional Eligibility: CHC conducts assessments of applicants’ abilities to determine their level of need for services and support.
• Financial Eligibility: Income and asset limits apply to applicants, and these vary depending on household size.
• Level of Care Determination: Each applicant undergoes a care assessment to establish the level of care required, ensuring that services align with their specific needs.

Individuals are NOT eligible for CHC if they are:

• Receiving long-term services and supports under the OBRA waiver but are NOT clinically eligible for nursing facility care.
• A participant in the Act 150 program and are not dually eligible for both Medicare and Medicaid.
• Receiving services for an intellectual or developmental disability through the DHS Office of Developmental Programs.
• Living in a state-operated nursing facility, including state veterans’ homes.

Navigating eligibility requirements can be a complex process, especially for family members new to Medicaid waivers. Support from caseworkers or advocacy groups can help caregivers and their loved ones manage the process smoothly.

Compensation for Caregivers under Community HealthChoices

Recognizing the vital role that family caregivers play, CHC offers opportunities for Pennsylvania family members to be paid for their caregiving services. Here’s a step-by-step guide on how caregivers can get compensated through CHC:

1. Caregiver Selection: Eligible CHC participants have the option to choose a family member to be their caregiver, as long as both parties agree.
2. Assessment and Approval: The chosen family caregiver undergoes an evaluation to confirm their capacity to provide the required care. Once approved, they can begin the caregiving role.
3. Care Plan Development: A personalized care plan is created with input from both the care recipient and the approved caregiver, outlining the specific services to be provided.
4. Compensation Process: Once the care plan is in place, the family caregiver can begin delivering services, and they are paid based on an established rate.
5. Documentation and Reporting: Caregivers must keep accurate records of services provided, including the dates, times, and tasks completed, which are essential for compensation processing.
6. Payment Processing: Family caregivers receive payment through the state’s Medicaid system, with specific procedures and schedules depending on state guidelines.

By supporting family caregivers financially, CHC not only alleviates some of the financial strain associated with caregiving but also underscores the value of family-based care in Pennsylvania’s healthcare system.