Home care through Community HealthChoices, OBRA and Act 150

Which Pennsylvania programs pay for home care?

Pennsylvania pays for in-home help with bathing, dressing, meals and the house, which the state calls personal assistance services, through several programs run by the Department of Human Services' Office of Long-Term Living. It's Your Home Care is an enrolled provider for three of them: Community HealthChoices, the OBRA waiver and the Act 150 program. Older adults who are not Medicaid-eligible may also get help through the OPTIONS program at the county Area Agency on Aging.

How does Community HealthChoices work?

Community HealthChoices is Pennsylvania's Medicaid managed care program for long-term services and supports. To qualify you must be 21 or older, enrolled in Medicaid, and either also have Medicare or need a nursing facility level of care. For many older adults and their families, it is the program that makes ongoing senior care at home possible instead of a move to a nursing home, and personal assistance services, the hands-on and household help we provide, are among the most common services.

The steps, in order:

1. Call the Independent Enrollment Broker (IEB) at 1-877-550-4227 (TTY 1-877-824-9346). The IEB is the state's enrollment contractor for home and community-based services.
2. A needs assessment. The IEB arranges an in-person visit, at home, in the hospital or in a nursing facility, to decide whether you need the level of help a nursing home provides (the state calls this functional eligibility).
3. The money side. The IEB helps with the Medicaid application, and your County Assistance Office decides whether you are financially eligible.
4. Choose a plan. You choose one of the three CHC managed care organizations; if you do not choose, one is assigned, and you can change plans later.
5. Choose a service coordinator. You pick a service coordinator, who works with you to build a person-centered service plan listing the services and hours approved.
6. Choose your agency. Tell your service coordinator which home care agency you want. You can name It's Your Home Care, and you can ask to change agencies later if care is not working.

Our guide to Community HealthChoices from the IEB call to the first caregiver visit covers each step, typical waits and what to ask.

What is the OBRA waiver?

The OBRA waiver is for younger adults, aged 18 to 59, who live with a severe developmental physical disability: a physical, sensory or neurological condition that began before age 22 and is expected to last indefinitely. To qualify, a person needs an intermediate care facility level of care and has substantial limitations in at least three major life activities, such as self-care, mobility or living independently. People who turn 60 while enrolled can keep their services. Personal assistance services are one of the waiver's services. Enrollment also starts with the IEB at 1-877-550-4227, and the County Assistance Office decides financial eligibility.

What is the Act 150 program?

Act 150 is a state-funded attendant care program for Pennsylvanians aged 18 to 59 with a physical impairment expected to last at least 12 months, who need a nursing facility level of care, are capable of directing their own care, and have gone through the Medicaid process and been found financially ineligible. It provides personal assistance services, a personal emergency response system and service coordination. Some people owe a small co-payment based on income. Our guide to the Act 150 program explains who it is for and how it connects to CHC.

Can you choose your home care agency?

Yes. In these programs, you choose who provides your services. In CHC you choose from the agencies in your plan's network; in OBRA and Act 150 you choose from enrolled providers. You do not have to accept the first agency suggested, and you can ask your service coordinator to make a change. Many people also have the option of directing their own care and hiring their own worker; the agency model is the choice for people who want an agency to recruit, train, schedule and supervise caregivers. Our page on in-home support for adults with disabilities discusses that choice.

What help can we provide through these programs?

We provide non-medical personal assistance: bathing, dressing, toileting, transfers, meals, medication reminders, housekeeping and laundry, within the hours and tasks your service plan approves. Skilled nursing, therapy and medical equipment come through other providers in your plan. Approved hours depend on assessed need; round-the-clock authorization is uncommon, and some families add privately paid hours or family coverage. Medicare does not pay for ongoing non-medical home care.

Not sure where to start, or whether we serve your area? Call (717) 695-2704. We can walk you through the steps and what to say to your service coordinator.