Pennsylvania Medicaid Waivers for Assisted Living Services

Communities that provide assistance with activities of daily living in Pennsylvania are either regulated as assisted living or personal care homes. These types of communities offer less medically intensive care than nursing homes while assisting with activities of daily living such as grooming or bathing. Pennsylvania’s Medicaid programs do not typically cover the cost of assisted living or personal care homes. However, several Medicaid waiver programs can cover the cost of some of the services that an assisted living community provides. These waiver programs also offer assistance with in-home care and skilled nursing care.

While Medicaid options for assisted living are limited, Pennsylvania operates two relevant Medicaid waivers, also known as medical assistance waivers. The two most relevant waivers for seniors looking for a level of care similar to an assisted living community are the Community HealthChoices waiver and the Living Independence for the Elderly waiver.

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Community HealthChoices is Pennsylvania’s mandatory Medicaid managed care program. As of 2020, other Medicaid programs, such as the Pennsylvania Department of Aging (PDA) waiver, have transitioned to Community HealthChoices. Seniors who qualify for both Medicare and Medicaid or receive long-term support through Medicaid to assist with activities of daily living are generally covered by Community HealthChoices.^[01]

What services does the CHC waiver cover?

The Community HealthChoices program is designed to help eligible seniors live in their homes and communities for as long as possible. Seniors select from several plans based on their location and their needs. Through these plans, seniors have access to services that promote independence and assist with some activities of daily living:

●    Adult day health services
●    Transportation services
●    Primary medical specialist care
●    Nursing and skilled nursing care
●    Recreational therapy
●    Personal care
●    Home-delivered meals
●    Homemaker services
●    Nursing facility services ^[02]

Who qualifies for the CHC waiver?

Seniors that qualify for medical assistance through Medicaid and require long-term care may be eligible for the CHC waiver if they meet the requirements of the program:

●    Eligible for both Medicare and Medicaid
●    Receive long-term services and support in the Attendant Care, Independence, COMMCARE, or Aging waivers
●    Receive services through the Omnibus Budget Reconciliation Act (OBRA) waiver and are clinically eligible for a nursing facility
●    Receive care in a nursing home paid for by Medicaid
●    Wish to receive long-term care services in their own home or another community setting
●    Does not receive services for an intellectual or developmental disability through the DHS’ Office of Developmental Programs
●    Is a resident of a state-operated nursing facility or state veterans’ home ^[03]

How do I apply for the CHC waiver?

The state of Pennsylvania offers several ways to apply for the Community HealthChoices waiver.

●    To apply for medical assistance benefits online, go to Pennsylvania’s benefits portal, COMPASS.
●    To apply over the phone, call the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
●    To apply through a caseworker, contact a local county assistance office or apply through the mail by downloading an application form from an assistance office website.

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The Living Independence for the Elderly (LIFE) waiver is a managed care program that allows seniors to live independently while receiving services that meet their health and personal needs. This waiver offers a comprehensive, all-inclusive package with various medical and supportive services, most of which are provided by staff who work at a LIFE day center. Program participants must live within a center’s service area.^[04]

Nationally, the program is known as the Program of All-Inclusive Care for the Elderly (PACE). All PACE providers in Pennsylvania should have “LIFE” in their name. Seniors who qualify for LIFE can also choose to participate in the CHC program if their needs are not met by LIFE coverage or they do not live near a LIFE center.

What services does the LIFE waiver cover?

Pennsylvania residents who live in the service area of a LIFE day center have access to a variety of care services. The LIFE program is geographically based, and the plan can be canceled if a senior moves out of the plan’s service area. Generally, the waiver grants access to the following:

●    Adult day health services to assist seniors’ medical needs
●    Emergency care such as ambulance rides and hospital visits
●    Coordination of end-of-life services such as hospice care
●    Access to hospital and nursing facility services
●    Access to in-home supportive care to help seniors live at home for as long as possible
●    Meals delivered to a senior’s home or to a LIFE day center
●    Transportation to medical appointments and to LIFE day center
●    Access to a wide array of medical specialists
●    Access to primary medical care, nursing care, and personal care
●    Physical, speech, and occupational therapies through eligible providers
●    Full calendars of recreational and socialization activities for seniors to enjoy at LIFE day centers
●    Homemaker services for seniors who need assistance around the house ^[05]

Who qualifies for the LIFE waiver?

To qualify for LIFE, seniors must meet several requirements:

●    Require the level of care needed for a skilled nursing facility or a special rehabilitation facility
●    Match the financial requirements as determined by your local county assistance office or be able to pay privately
●    Reside in an area served by a LIFE provider
●    Be able to be safely served in the community as determined by a LIFE provider

How do I apply for the LIFE program?

To locate a LIFE provider in your area, call 1-844-824-3655 or 1-833-254-0690. To search for a LIFE program by zip code, use the Locate a LIFE Program tool.

A Place for Mom’s Senior Living Advisors can help you or your loved ones navigate the complexities of finding senior living services that meet your budget. Talk with an expert today to learn more about Pennsylvania’s senior living and home care services.