8,000+
FreedomCare helps Chester County families get paid through Pennsylvania Medicaid for the care they're already giving a parent, sibling, or other loved one at home.
Chester County has about 548,000 residents, and roughly 18 percent are 65 or older. That share is just below the Pennsylvania state average, but the county has been growing fast, including the older population. The older residents are concentrated in long-time homeowner communities across Tredyffrin, Easttown, West Chester, Westtown, Willistown, the area around Phoenixville, and the country towns of southern Chester. The Kennett Square area, home to most of the country's mushroom growing operations, also has a meaningful Latino population that includes long-term families and more recent arrivals.
Most families would rather keep care at home than move someone into a nursing facility. Medicaid home care exists to make that possible. In Pennsylvania, the program that lets a Medicaid member receive personal care at home, choose their own caregiver, and direct the day-to-day work is delivered through Community HealthChoices and a set of related waivers. For many Chester County families, the person they choose to provide that care is a relative they already trust, often an adult child still living in the area.
Pennsylvania's Medicaid program, called Medical Assistance, pays for long-term services and supports through a few connected pieces. Knowing how they fit together makes the next steps easier to plan.
Community HealthChoices is Pennsylvania's managed long-term services and supports program. It serves adults 21 and older who are dually eligible for Medicare and Medicaid or who qualify for Medicaid and need a nursing facility level of care. CHC is run by three managed care organizations: AmeriHealth Caritas Community HealthChoices, UPMC Community HealthChoices, and PA Health & Wellness. Chester County is part of the Southeast CHC zone, along with Philadelphia, Bucks, Delaware, and Montgomery counties. AmeriHealth Caritas operates as Keystone First Community HealthChoices in this region.
Once enrolled in CHC, a participant chooses an MCO and works with a service coordinator to put together a person-centered care plan. Personal assistance, home health, adult day services, home modifications, and durable medical equipment are all part of the benefit, alongside the participant-directed option that allows a family member to be paid as the caregiver. The right MCO is usually the one whose network already includes the participant's primary care doctor, specialists, and preferred hospital system. In Chester County, that often means Penn Medicine Chester County Hospital in West Chester, Main Line Health (Paoli and Bryn Mawr), Tower Health (Phoenixville and Pottstown), or one of the area's federally qualified health centers, but the choice of MCO belongs to the participant.
Personal Assistance Services is the actual hands-on category of help that most families think of when they hear "home care." PAS covers non-medical support with daily activities, the kind of help that makes living at home workable when someone cannot manage everything on their own. It is delivered through CHC for adults 21 and older and through other waiver programs for younger adults. A PAS attendant in Chester County typically helps with:
Home and Community Based Services, usually shortened to HCBS, are the Medicaid services that let a person receive long-term care at home rather than in an institution. Pennsylvania runs HCBS through two state offices. The Office of Long-Term Living administers waivers for older adults and adults with physical disabilities. The Office of Developmental Programs administers waivers for people with intellectual disabilities and autism.
For adults 21 and older with long-term care needs, most home care now flows through CHC. For adults 18 to 59 with physical disabilities who do not need a nursing facility level of care, the OBRA Waiver uses the same participant-directed model. The Act 150 Attendant Care Waiver is a separate, state-funded program for adults with physical disabilities who do not qualify for Medicaid but still need attendant care to live independently. If you are caring for an adult with an intellectual or developmental disability, the relevant waivers, including Consolidated and Person/Family Directed Support, are run by the Office of Developmental Programs through a separate eligibility pathway.
| Program | Who it serves | Funded by |
|---|---|---|
| Community HealthChoices (CHC) | Adults 21+ who need a nursing facility level of care, or who are dually eligible for Medicare and Medicaid | Pennsylvania Medicaid (Medical Assistance), administered by three managed care organizations |
| OBRA Waiver | Adults 18–59 with severe physical disabilities who do not need a nursing facility level of care | Pennsylvania Medicaid, administered by the Office of Long-Term Living |
| Act 150 Attendant Care | Adults 18–59 with severe physical disabilities who are not Medicaid-eligible | State-funded program, administered by the Office of Long-Term Living |
| ODP Waivers | Adults and children with intellectual disabilities or autism | Pennsylvania Medicaid, administered by the Office of Developmental Programs |
Eligibility and benefits are determined by Pennsylvania and its managed care partners. Program rules can change.
This is the question most families ask first, so it deserves a direct answer. Pennsylvania does allow family members to be paid caregivers through the participant-directed option in CHC and several other waiver programs, with limits on who qualifies. The FreedomCare guide to getting paid as a family caregiver in Pennsylvania walks through the details, but here is what most Chester County families need to know.
Consumer-directed care, called participant-directed services under CHC, lets the person receiving care act as the employer of their own caregiver. Instead of an agency assigning an outside aide on its own schedule, the participant chooses who provides their care, sets the schedule, and directs the day-to-day work. A Financial Management Services provider like FreedomCare handles the paperwork behind the scenes, including payroll, tax withholding, and background checks. The participant stays in control of the care; FreedomCare keeps the system running.
Under CHC participant-directed services, the paid caregiver can be a family member, a friend, or a neighbor, as long as that person is at least 18 and passes the required background checks. An adult child caring for a parent is one of the most common arrangements, and siblings, grandchildren, and other relatives are also accepted in most cases.
There are important limits. Under CHC, a spouse is typically not eligible to be paid as a caregiver, and neither is a legal guardian or someone holding power of attorney for the care recipient. If you are caring for a husband or wife in Chester County, the paid caregiver under CHC would generally need to be someone else, such as an adult child or another trusted relative. Family caregiver rules differ across Pennsylvania programs and can change, so it is worth confirming the current rule for any specific situation before counting on it.
Beyond the relationship rules, a few practical requirements apply to anyone paid through participant-directed services:
Approval is never automatic. The MCO authorizes the service plan, the Financial Management Services provider verifies the caregiver, and the state oversees the program. FreedomCare can help families understand the process, but only Pennsylvania and its managed care partners can approve the care arrangement.
| Generally allowed | Generally not allowed |
|---|---|
| Adult child caring for a parent | Spouse (husband or wife), in most cases |
| Other relatives, such as a sibling, grandchild, or in-law | A legal guardian of the care recipient |
| A trusted friend or neighbor (age 18 or older) | Anyone who does not clear the required background checks |
Each caregiver must clear background checks and clearances. Caregiver rules vary by program and can change. Confirm current details with the participant's MCO or the Financial Management Services provider.
Chester County's scale, the contrast between its affluent townships and its working-class boroughs, and the active mushroom-industry economy in the south all shape the home care picture here. A few figures help put it in context.
Chester County has a network of local offices and organizations that help older adults, people with disabilities, and the family members caring for them. These are good places to start, alongside FreedomCare.
FreedomCare works with families across Pennsylvania, including Chester County, who want to be paid for the care they are giving at home. We are not a nursing home, and we are not an agency that sends a stranger to your door. We support the participant-directed model, where the person receiving care chooses someone they already trust.
In practice, that means we help with the parts that tend to overwhelm families. We help you understand whether CHC participant-directed services are a fit and what the eligibility process looks like. We guide the caregiver through onboarding and the required background checks. Once care begins, we handle payroll and tax withholding so the caregiver gets paid correctly and on time. And we stay available when questions come up later, because they will.
Yes. Pennsylvania Medicaid, called Medical Assistance, pays for Personal Assistance Services and other long-term services and supports at home through Community HealthChoices and related waivers. A Chester County resident enrolled in Medical Assistance who is assessed as needing a nursing facility level of care can typically receive Medicaid-funded home care through CHC.
In many cases, yes. Pennsylvania's CHC participant-directed program allows the person receiving care to choose their own caregiver, and that caregiver can be a relative, friend, or neighbor who is at least 18 and passes the required background checks. An adult child caring for a parent is a common arrangement.
Under Community HealthChoices, a spouse is typically not eligible to be paid as a caregiver, and neither is a legal guardian or someone holding power of attorney. Another relative, such as an adult child, can usually serve in that role instead. Caregiver rules vary across Pennsylvania programs and can change.
CHC is administered in the Southeast zone by AmeriHealth Caritas (operating as Keystone First Community HealthChoices), UPMC Community HealthChoices, and PA Health & Wellness. The right MCO is usually the one whose network already includes the participant's primary care doctor, specialists, and preferred hospital system. In Chester County, that often means Penn Medicine Chester County Hospital, Main Line Health, or Tower Health, but the choice belongs to the participant.
Possibly. CHC eligibility uses Medicaid financial rules that include specific provisions for long-term care, which differ from regular Medicaid health coverage. Many Chester County families with significant retirement assets or a paid-off home still qualify once they apply and are assessed. The only way to know is to contact the Independent Enrollment Broker and start the process.
You can apply for Medical Assistance through the state's COMPASS portal. For CHC specifically, the Pennsylvania Independent Enrollment Broker at 1-877-550-4227 is the central point of entry. Once eligibility is established, you will be assessed for the level of care you need and connected with an MCO. FreedomCare can walk you through each step.
There is no single answer. The number of approved hours is determined by the MCO based on the participant's assessed need. Two people in the same Chester County township can be approved for very different amounts of care depending on their individual circumstances.
Yes. FreedomCare works with families across Pennsylvania, including Chester County and the wider Southeast CHC zone. We help eligible families understand the participant-directed option, get caregivers onboarded, and manage payroll so care can continue at home.
If you are caring for someone in Chester County and you are not sure whether Medicaid can help, the next step is simple. Reach out to FreedomCare. We will talk through the person's situation, explain how Community HealthChoices and participant-directed services work, and help you figure out whether it is worth pursuing. There is no cost to ask.
You have been doing the hard part already. Let us help you find out whether Pennsylvania Medicaid can support the care you are giving.
Important Disclaimer: This page is provided for general informational purposes only and does not constitute legal, financial, or medical advice. Eligibility for Pennsylvania Medical Assistance, Community HealthChoices, and related waivers is determined by the Commonwealth of Pennsylvania and its managed care partners, and approval is never guaranteed. Program rules, covered services, and caregiver requirements may change. Spouse and family caregiver eligibility also varies by program and over time. Always confirm current requirements with the Pennsylvania Department of Human Services, the Pennsylvania Independent Enrollment Broker, or the participant's managed care organization (MCO) before making decisions.
State overview of Community HealthChoices (CHC), including how it works, who qualifies, and how to apply.
dhs.pa.gov/Services/Disabilities-Aging/Pages/Community-HealthChoices.aspxApply for Medical Assistance and related Pennsylvania benefits online.
compass.state.pa.usFront door for CHC and OBRA enrollment. Call 1-877-550-4227 to begin an application.
paieb.comAdministers CHC, OBRA, Act 150, and other waivers for older adults and adults with physical disabilities.
dhs.pa.gov/about/Pages/OLTL.aspxStatewide office supporting older Pennsylvanians and the Area Agencies on Aging.
aging.pa.govArea Agency on Aging serving Chester County, with information, in-home services, and caregiver support.
chesco.org/202/Aging-ServicesFree civil legal help for low-income residents of Chester, Bucks, Delaware, and Montgomery counties.
lasp.orgCounty population, age, income, poverty, and health insurance statistics.
census.gov/quickfacts/chestercountypennsylvaniaCounty-level data on health outcomes, access to care, and related factors.
countyhealthrankings.orgIndependent data on Medicaid enrollment and spending in Pennsylvania.
kff.org/state-category/medicaid-chip/We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Pennsylvania every day.
We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Pennsylvania every day.
You’ve been caring for your loved one because it’s the right thing to do. FreedomCare can help you navigate Pennsylvania’s PAS program, understand your options, and take the first step toward care from someone you trust while they get paid for it.
