How to Pay for Home Care in Pennsylvania: Private Pay, Insurance, VA Benefits, OPTIONS, and Medicaid Waivers (2026)

Start here: what Medicare does and does not cover

The most common misunderstanding we hear is that Medicare will pay for a caregiver at home. It will not, except in a narrow case. Medicare Part A and B cover part-time or intermittent skilled nursing and therapy at home when a doctor orders it, the person is homebound, and a Medicare-certified home health agency provides it. Medicare.gov states plainly that it does not pay for custodial or personal care such as bathing, dressing and toileting, or for homemaker services, when that is the only care a person needs. Some Medicare Advantage plans include a small in-home support benefit; check your plan.

Everything below is how Pennsylvania families actually pay for the non-medical care that keeps a parent at home.

1. Private pay

Two private-pay tools are underused:

• Life insurance conversion. A policy with cash value, or sometimes a term policy, can be sold or converted into a long-term care benefit account that pays the care provider monthly. It requires no health underwriting and is a Medicaid-qualified spend-down.
• Reverse mortgage (HECM) line of credit. For homeowners 62 and older who intend to stay in the home, a line of credit drawn monthly for care can be more efficient than selling investments. Interest accrues and equity declines; get independent counseling, which HUD requires.

2. Long-term care insurance

If your parent bought a long-term care policy, it almost certainly covers non-medical home care. Most policies pay when a licensed health care practitioner certifies that the insured needs help with two of six activities of daily living (bathing, dressing, toileting, transferring, continence, eating) for at least 90 days, or has a severe cognitive impairment that requires supervision. After an elimination period (commonly 90 days) the policy provides benefits for eligible care under the policy.

Carriers generally require care from a licensed agency and want a plan of care, daily caregiver notes showing which activities were assisted, and itemized invoices. Cash paid to an unlicensed individual is frequently denied. We provide the documentation carriers ask for; see how long-term care insurance pays for home care.

3. VA benefits for veterans and surviving spouses

The VA pension’s Aid and Attendance and Housebound add-ons are the most common veteran benefit used for home care.

A VA-accredited claims agent or your county Veterans Affairs office can help; be wary of anyone who charges to “help you qualify.”

Both start with the veteran’s VA social worker.

4. The OPTIONS program (age 60 and over)

OPTIONS is Pennsylvania’s own in-home services program for residents 60 and older, funded by the Department of Aging and run by each county’s Area Agency on Aging (AAA). There is no income limit.

Hours are limited by county funding and waiting lists exist, so call early. Every one of our county pages lists the local AAA phone number.

5. The Pennsylvania Caregiver Support Program

Also run by the AAAs, the Caregiver Support Program helps the unpaid family caregiver rather than the care recipient. There is no financial test to enroll; the reimbursement percentage slides with the care recipient’s income and phases out near 380 percent of the poverty level. It is a reimbursement, not a wage, so it is not the same as the “get paid to care for a family member” programs advertised elsewhere.

6. Community HealthChoices (Medicaid)

Community HealthChoices (CHC) is Pennsylvania’s Medicaid managed long-term services and supports program for adults 21 and older who are eligible for Medicaid and need a nursing-facility level of care (or are dual-eligible for Medicare and Medicaid). It pays for personal assistance services at home through three managed care organizations: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices.

The process: call the Independent Enrollment Broker at 1-877-550-4227; the county AAA performs a functional assessment; the County Assistance Office determines financial eligibility; a decision is due within 90 days; you choose a plan and a service coordinator, who authorizes weekly hours. You then have the right to choose any willing and qualified provider in the network. Pennsylvania closed its older Aging, Independence, Attendant Care and CommCare waivers and moved those participants into CHC by 2020; if an agency still advertises those waivers, its information is out of date. The OBRA waiver remains for adults with severe developmental physical disabilities who do not meet CHC criteria.

7. The Act 150 Program (ages 18 to 59, not Medicaid-eligible)

Act 150 is a state-funded attendant care program for Pennsylvanians 18 to 59 with a physical disability who need a nursing-facility level of care, can direct their own care, and are not financially eligible for Medicaid. It pays for personal assistance services, a personal emergency response system and service coordination. Apply through the Independent Enrollment Broker. Act 150 participants who later become Medicaid-eligible move into CHC.

Putting it together

A realistic plan for a Pennsylvania family often looks like this:

1. Week 1: Start private-pay care for the hours that are urgent. Get the written care plan.
2. Week 1–2: Call the AAA about OPTIONS and the Caregiver Support Program (age 60+), or the Independent Enrollment Broker about CHC or Act 150 if Medicaid eligibility or a disability under 60 is in play.
3. Week 1–4: If there is a long-term care policy, request the claim forms and the physician certification; ask the agency for its license number, plan of care and notes.
4. If a veteran: Contact the county Veterans Affairs office or an accredited claims agent about Aid and Attendance, and ask the VA social worker about Veteran-Directed Care.
5. Ongoing: Keep every invoice. Ask a tax professional whether the care is deductible.

We help families with this sequence every week. Call (717) 695-2704 or request a consultation and we will walk through which options fit your situation and your county.