Eligibility and Enrollment

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What are Home and community based services? HCBS provides for supports and services beyond those covered by the Medical Assistance (also referred to as Medicaid) program that enable a person to remain in a community setting rather than being admitted to a Long Term Care Facility. Currently the Department of Human Services administers 12 HCBS programs. Each HCBS program has its own eligibility requirements and services. Home and Community Based Services are also known as Waiver Funded Services or Waiver Programs. The name waiver comes from the fact that the federal government “waives” medical assistance rules for institutional care in order for Pennsylvania to use the funds for HCBS.

Do I Qualify?

Pennsylvania residents must be “waiver eligible” to qualify. This includes all adults 60 years or older, or those 18 and older with certain disabilities or medical conditions. Individuals must also qualify financially with limited income or assets to be waiver eligible. Call PCC today and we will help evaluate and assist to determine waiver eligibility for free!

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Who is eligible for waiver services?

1. Individuals are eligible for CHC if they are 21 years old or older and:

  • Dually eligible for Medicare and Medicaid. In CHC, that includes individuals with Medicare Part A and/or Part B; or
  • Qualify for Medicaid long-term services and supports (LTSS) because they need the level of care provided by a nursing facility.

2. Individuals are NOT eligible for CHC if they:

  • Are a person with an intellectual or developmental disability receiving services beyond supports coordination through the Department of Human Services’ Office of Developmental Programs (ODP); OR
  • Are a resident in a state-operated nursing facility, including state veterans’ homes.
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WHAT ARE THE INCOME AND RESOURCE LIMITS FOR LTSS?

To qualify for Long-Term Services and Supports (LTSS), including Home and Community-Based Services (HCBS) and nursing facility services, applicants must meet both income and resource (asset) requirements set by the Pennsylvania Department of Human Services (DHS). These limits are updated each year and may differ depending on whether a person is applying as an individual or as part of a married couple.

 

Special rules also protect a portion of resources for a spouse who is not applying for LTSS. Because eligibility rules are complex and change annually, we encourage you to review the most current information directly on the PA DHS website or contact us for assistance. Our team can help you understand how the rules may apply to your situation and guide you through the application process.

Have Other Questions or Want to Know
How To Apply For Services?

 

Call us today! We help to determine program eligibility and walk people through the application process, free of charge.