For many Philadelphia families, the Community HealthChoices (CHC) Medicaid Waiver is the difference between affording quality in-home care and not. It’s the Pennsylvania program that pays for home care, personal assistance, and other long-term services for older adults and adults with physical disabilities who qualify financially and clinically.
But CHC is also confusing. The application process is long. The rules feel like a maze. And families often get conflicting information from well-meaning relatives, hospital social workers, and the agencies they call. This guide walks you through what CHC actually covers, who qualifies, how to apply, what to expect, and what to do if your loved one is denied.
If you already know CHC is the right path, see our care setup process page for the realistic 30 to 45 day timeline from your first call to the first caregiver visit.
What Is the CHC Medicaid Waiver?
CHC stands for Community HealthChoices. It’s Pennsylvania’s managed long-term services and supports program for adults age 21 and older who are eligible for Medical Assistance and need a nursing facility level of care.
Despite the name, most CHC services are designed to help people stay out of nursing facilities and in their own homes. The waiver pays for things like:
- In-home personal care (bathing, dressing, meals, mobility help)
- Home health aide services
- Adult day services
- Personal Emergency Response Systems (PERS)
- Service coordination
- Home and vehicle modifications for safety (grab bars, ramps, etc.)
- Respite care for family caregivers
- Other supports that help people maintain independence at home
Pennsylvania transitioned long-term Medicaid services into CHC in 2018 as part of a broader move toward managed care. Today, every CHC participant is enrolled in one of three Managed Care Organizations (MCOs) that coordinate their services — more on those below.
This is the single most common confusion we see. Medicare is federal health insurance for adults 65 and over (and some younger adults with disabilities). It covers doctor visits, hospital stays, and short-term rehab. Medicare does not pay for ongoing in-home care. CHC is a Pennsylvania Medicaid program specifically designed to cover long-term in-home care and supports for people who would otherwise need a nursing facility.
Who Qualifies for the CHC Waiver?
To be approved for CHC, your loved one must meet three eligibility tests: age, financial, and clinical. All three must be satisfied for approval.
Age Eligibility
Your loved one must be 21 or older. There is no upper age limit.
Financial Eligibility
Determined by the County Assistance Office (CAO) based on income, assets, and marital status. Details below.
Clinical Eligibility
Your loved one must require a “nursing facility level of care,” determined through an in-home Functional Eligibility Determination.
A Closer Look at Financial Eligibility
The County Assistance Office reviews three things:
Income
Pennsylvania uses what’s called the “300% rule” — meaning monthly income generally must be at or below 300% of the federal SSI (Supplemental Security Income) benefit rate. The exact dollar amount changes each year, so check the current limit with your CAO or a benefits counselor before assuming your loved one is over the line.
Assets and Resources
A single applicant generally can have no more than $2,000 in countable resources. Several types of assets are excluded from this count, including:
- The primary residence (in most cases, while occupied or if the applicant intends to return)
- One vehicle
- Personal belongings and household goods
- Certain pre-paid burial plans
- A modest amount of life insurance
Marital Status
If your loved one is married and only one spouse needs care, “spousal impoverishment” rules protect a portion of the couple’s combined income and assets so that the healthy spouse isn’t impoverished by the application. These rules are technical, and an elder law attorney or qualified benefits counselor can help your family work through them correctly.
A Closer Look at Clinical Eligibility
Your loved one must require a “nursing facility level of care,” meaning they need significant help with multiple activities of daily living (ADLs) — bathing, dressing, transferring (moving from bed to chair), toileting, and eating. Cognitive impairments such as dementia that affect safety also count.
This is determined by an in-home Functional Eligibility Determination (FED) conducted by a nurse from Pennsylvania’s Independent Enrollment Broker (currently Maximus). The visit usually lasts about an hour, and it’s one of the most important hours in the entire process — accurate descriptions of your loved one’s real daily needs are critical.
How to Apply for the CHC Waiver in Pennsylvania
The application process involves several state and county agencies and typically takes 30 to 45 days from your first call to the first caregiver visit. Here’s the short version:
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1
Contact the Independent Enrollment Broker (Maximus)
Call 1-877-550-4227 to start the application, or begin online. This step initiates both the clinical and financial eligibility processes.
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2
Complete the financial application
The County Assistance Office (CAO) will request income and asset documentation. Respond quickly to any requests so the file doesn’t sit waiting on missing paperwork.
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3
Complete the in-home Functional Eligibility Determination
A nurse from Maximus will visit your loved one’s home (usually about an hour) to evaluate their need for help with daily activities. Accurate descriptions of real needs matter — under-reporting almost guarantees a denial.
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4
Choose a Managed Care Organization (MCO)
Once approved, your loved one will be enrolled in one of three MCOs. You get to choose. (More on each below.)
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5
Work with your Service Coordinator on a Person-Centered Service Plan
Your assigned Service Coordinator will determine the hours and types of care your loved one is authorized to receive each week.
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6
Authorize a home care agency to begin services
Apple Home Care (or whichever agency you choose) is officially cleared to start care. This is when the first caregiver walks through the door.
See our care setup process page for what to expect during each phase — including what we do for your family during the wait.
The Three CHC Managed Care Organizations (MCOs)
Once your loved one is approved, they will be enrolled in one of three CHC Managed Care Organizations. You get to choose. Each MCO has its own provider network, service coordinators, and operational style — but all three are required to cover the same core CHC services.
Keystone First Community HealthChoices
Part of AmeriHealth Caritas. The largest CHC plan in southeastern Pennsylvania, with a strong provider network in Philadelphia and the surrounding counties.
PA Health & Wellness
Affiliated with Centene. Focuses on integrated medical and long-term care coordination, which can be helpful for families managing multiple chronic conditions alongside CHC services.
UPMC Community HealthChoices
Part of the UPMC Health System. Strongest network for participants who already use UPMC primary care or specialists, since care coordination tends to be smoother when the same system handles both medical and long-term services.
Apple Home Care works with families across all three CHC MCOs. During your free consultation, we can help you understand which network best fits your loved one’s existing providers before you make the selection.
What CHC Covers (and What It Doesn’t)
The waiver is generous in some areas and explicitly limited in others. Knowing the difference up front saves families from disappointment later.
CHC generally covers
- Personal care services (in-home help with daily activities)
- Companion services
- Home health aide services
- Adult day services
- Personal Emergency Response Systems
- Home and vehicle modifications for safety
- Respite care for family caregivers
- Service coordination
- Some therapy services when medically necessary
CHC generally does NOT cover
- 24/7 live-in care for most participants — hours are authorized based on assessed need
- Services delivered outside of Pennsylvania
- Cosmetic services
- Items considered “convenience” rather than medical necessity
- Skilled nursing care that would be billed through Medicare
Common Myths That Trip Families Up
We hear the same misunderstandings on almost every consultation. Here are the most common — and the truth behind each.
TruthIncome limits are higher than many people think — and spousal impoverishment rules protect a healthy spouse’s income and assets. Don’t assume your loved one is over the line without checking the actual current limits.
TruthThe primary residence is generally exempt while the applicant or spouse is living there, or if there is intent to return. Owning the home doesn’t, by itself, disqualify anyone.
TruthYou can choose the agency. The agency then matches the right caregiver to your loved one based on personality, schedule, and skill set. You don’t pick caregivers from a public pool.
TruthDenials can be appealed, and appeals are often successful — especially when the original assessment underestimated functional needs. If your loved one is denied, don’t walk away without exploring an appeal.
TruthThe full process from first call to first visit averages 30 to 45 days. Plan accordingly, and consider interim private pay if your loved one needs help right now.
What to Do If Your Loved One Doesn’t Qualify
If your loved one is denied for CHC, you still have options. We’ve helped families pursue every one of these:
- Appeal the decision. You generally have 30 days from the denial notice to file an appeal. Many denials are overturned, especially when the original functional assessment underestimated real daily needs.
- Reapply if circumstances change. A drop in income, depletion of assets, or a decline in health can shift eligibility.
- Explore Veterans benefits. If your loved one is a wartime veteran or the surviving spouse of one, the VA Aid & Attendance benefit can provide significant monthly support toward in-home care.
- Long-term care insurance. If your loved one has a long-term care insurance policy, it likely covers in-home care in part or in full. Pull out the policy and review benefits.
- Medicaid spend-down planning. An elder law attorney can help structure assets in ways that support eligibility down the road. This is a legal process, not a workaround.
- Combination strategies. Many families pay privately for a few hours a week and add CHC coverage once approved.
How Apple Home Care Helps Through the CHC Process
Many agencies will sign you up, hand you a packet of paperwork, and disappear until you’re approved. We don’t work that way. Here’s how we stay engaged:
- Application support. We sit on the phone with you and Maximus, help you fill out forms correctly, and make sure nothing critical is missing.
- Assessment coaching. Before the in-home Functional Eligibility Determination, we walk your family through what will be asked and how to describe your loved one’s real needs accurately.
- Document help. We provide a clear checklist of every document you’ll need for the financial review and help you gather them.
- Status updates. We follow up with Maximus, the County Assistance Office, and the MCO on your behalf so you’re not the one chasing paperwork.
- Interim private pay options. If your loved one needs help right now and can’t safely wait, we can start short-term private pay and transition to CHC coverage once approved.
- Honest answers. If we think your loved one is unlikely to qualify, we’ll tell you and help you understand other paths instead of leaving you on your own.
See our care setup process page for what happens at each phase from first call to first caregiver visit.
Frequently Asked Questions About the CHC Waiver
What’s the income limit for CHC in Pennsylvania?
Pennsylvania uses a “300% rule” — monthly income generally must be at or below 300% of the federal SSI benefit rate. The dollar amount changes each year, so check the current limit with your County Assistance Office or a qualified benefits counselor before assuming your loved one is over the line. Spousal impoverishment rules can also protect a portion of a couple’s income when only one spouse needs care.
How long does the CHC application take?
Plan for 30 to 45 days from your first call to Maximus to the first caregiver visit. The timeline involves Maximus, the County Assistance Office, and the MCO, each with their own paperwork and waiting periods. The single biggest cause of delay is missing or incomplete documentation, so responding quickly to every request keeps the file moving.
Can my loved one keep their home and qualify for CHC?
In most cases, yes. The primary residence is generally exempt as a countable asset while the applicant or their spouse is living there, or if there is intent to return. Owning a home does not, by itself, disqualify someone from CHC.
What’s the difference between CHC and Medicare?
Medicare is federal health insurance for adults 65 and over (and some younger adults with disabilities). It covers doctor visits, hospital stays, and short-term rehabilitation, but it does not pay for ongoing in-home care. CHC is a Pennsylvania Medicaid program specifically designed to cover long-term in-home care and supports for people who would otherwise need a nursing facility level of care. Many people qualify for both at the same time.
Can I switch CHC MCOs after enrollment?
Yes. CHC participants can change MCOs once a year during open enrollment, and at certain other times for qualifying reasons. If your current MCO isn’t working well — for example, if your providers aren’t in network — your Service Coordinator can explain the steps for switching.
What if I’m not happy with my Service Coordinator?
You can request a different Service Coordinator from your MCO. Service Coordinators are key to making CHC work, so if the relationship isn’t right, it’s worth asking for a change rather than struggling through it.
Does Apple Home Care work with all three CHC MCOs?
Yes. We work with families across all three Managed Care Organizations — Keystone First Community HealthChoices, PA Health & Wellness, and UPMC Community HealthChoices. We can help you understand which network fits your loved one’s existing providers before you make the selection.
Can my loved one get care while the CHC application is pending?
Yes — through private pay. If your loved one needs help immediately and can’t safely wait the 30 to 45 days for CHC approval, we can start a short-term private pay arrangement and transition to CHC coverage once the waiver is in place. Many families use this approach to avoid a dangerous gap in support.
Does it matter that my loved one already lives with us?
Not for CHC eligibility itself. CHC is about your loved one’s clinical and financial situation, not their housing arrangement. Care can be delivered in your home, your loved one’s home, or in a shared living situation — whatever supports their independence.