Pennsylvania Medical Assistance for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex — consult a benefits counselor or elder law attorney
Community HealthChoices (CHC) covers long-term care in Pennsylvania
Community HealthChoices: Pennsylvania's long-term care managed care program
Community HealthChoices launched in January 2018 in Southwest Pennsylvania (the zone covering Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington, and Westmoreland counties). Phase 2 followed in January 2019 in Southeast Pennsylvania. Phase 3 — the final statewide expansion — went live in January 2020, completing the transition for all remaining counties. The phased approach was unusual in its scale; Pennsylvania moved the state's entire dual-eligible population into CHC over three years, replacing waivers that had operated for decades.
CHC is administered by five managed care organizations across five geographic zones. Each zone is served by all five CHC plans, allowing enrollees a choice. The five MCOs are:
- Aetna Better Health of Pennsylvania
- Health Partners Plans
- PA Health and Wellness
- UPMC For You
- AmeriHealth Caritas/Keystone First (Vista Health Plan)
Enrollment into CHC is handled through an Independent Enrollment Broker (IEB) — a neutral third party under contract with DHS. Contact the IEB at 1-877-398-5346 to enroll, switch plans, or get help understanding your CHC options.
Who is eligible for Community HealthChoices?
Per DHS, CHC covers individuals who are 21 years old or older and meet one of the following criteria:
- Dually eligible for Medicare and Medicaid (and not in an excluded category)
- Receiving long-term services and supports through the Attendant Care, Independence, COMMCARE, or Aging waivers (these waivers transitioned into CHC)
- Receiving services in the OBRA waiver and determined nursing facility clinically eligible
- Receiving nursing facility care paid for by Medicaid
- An Act 150 participant who is dually eligible for Medicare and Medicaid
Individuals with intellectual or developmental disabilities receiving services through DHS's Office of Developmental Programs are not enrolled in CHC. Residents of state-operated nursing facilities are also excluded. Pennsylvanians who are 55 or older and meet nursing facility level of care can choose the LIFE program (Living Independence for the Elderly) as an alternative to CHC — a PACE-like model providing day health services.
Nursing facility coverage under Medical Assistance
Medicaid pays for nursing facility care in Pennsylvania when a person meets both financial and clinical eligibility requirements. Financial eligibility follows non-MAGI rules: the individual must have low enough income and assets, and the nursing facility must be licensed and enrolled as a Medical Assistance provider.
Pennsylvania applies an individual resource limit of $8,000 for nursing facility applicants (per DHS guidance). Income rules for nursing facility residents follow the post-eligibility rules: the resident contributes most of their income toward their care (the "patient pay amount"), retaining a personal needs allowance of $45/month. If the resident has a community spouse, the income rules are more generous — the community spouse may retain a Minimum Monthly Maintenance Needs Allowance (MMMNA).
Pennsylvania enforces a 60-month (five-year) asset transfer look-back period. Assets transferred below fair market value within 60 months of a nursing facility application trigger a period of ineligibility. Transfers to a community spouse or a disabled child are exempt.
Home- and community-based services: helping people stay at home
CHC's stated goal is to serve more Pennsylvanians in community settings rather than nursing facilities. Home- and community-based services available through CHC include personal care (help with bathing, dressing, eating), home health aide services, adult day services, respite care, home modifications, assistive technology, and participant-directed services where the enrollee hires and manages their own care workers.
Research published in JAMA Health Forum (2023, Roberts et al.) found that CHC enrollment in Pennsylvania was associated with an increase of 0.61 HCBS days per month per enrollee compared to those remaining in traditional Medicare — confirming CHC's shift toward community-based care.
To request CHC or HCBS enrollment, apply through COMPASS or call DHS at 1-800-692-7462. You can also request a referral directly through the COMPASS website for home- and community-based services that are not applied for through the standard COMPASS application.
Spousal protections when one spouse enters a nursing facility
Federal law protects the assets and income of the community spouse (the spouse not in a nursing facility) from being fully depleted to pay for the institutionalized spouse's care. In Pennsylvania, the community spouse may retain:
- Community Spouse Resource Allowance (CSRA): up to $154,140 in countable resources (2026 federal maximum — verify current PA figure with DHS or a benefits counselor)
- Minimum Monthly Maintenance Needs Allowance (MMMNA): the community spouse retains enough income to cover basic living expenses, with a minimum floor and maximum cap set annually
- The primary residence: not counted as a resource when the community spouse lives there
- One vehicle: excluded from resource calculations
Pennsylvania's Medicaid estate recovery program
Pennsylvania operates a Medicaid Estate Recovery Program (MERP) as required by federal law. After a Medical Assistance recipient who received nursing facility services, HCBS waiver services, or related services dies, DHS may file a claim against the recipient's estate to recover the cost of those services. Recovery applies to individuals who were 55 or older when they received services, and to any age for nursing facility care.
Pennsylvania limits estate recovery to probate assets — the program does not pursue jointly held property that passes outside of probate (such as jointly held real estate with a right of survivorship) in most circumstances. However, circumstances vary, and the rules are technical. Hardship waivers are available if recovery would cause undue hardship to surviving household members.
Recovery is deferred while a community spouse, a minor child, or a blind or disabled child is living. Consult an elder law attorney before transferring property if a family member is enrolled in long-term care Medicaid.
LIFE program — Pennsylvania's PACE alternative
Spousal impoverishment protections at a glance
Federal law (42 U.S.C. § 1396r-5) protects the community spouse when the other spouse enters a nursing facility or Community HealthChoices. Pennsylvania applies these protections per DHS nursing facility rules.
| Protection | 2026 amount | Notes |
|---|---|---|
| Community Spouse Resource Allowance (CSRA) | Up to ~$154,140 | 2026 federal maximum; verify current PA figure with DHS or a benefits counselor |
| Minimum Monthly Maintenance Needs Allowance (MMMNA) | Set annually | Community spouse retains enough income to cover living expenses; minimum floor and maximum cap adjusted each January |
| Institutionalized spouse asset limit | $8,000 | Per DHS guidance; countable resources only; home (while community spouse occupies it), one vehicle, and personal effects are exempt |
| Personal needs allowance (nursing facility resident) | $45/month | Retained by the institutionalized spouse from their income each month |
Pennsylvania's $8,000 individual asset limit is notably lower than some states (NY: $31,175; TX: $2,000). Source: DHS nursing facility eligibility guidance; 42 U.S.C. § 1396r-5. Consult DHS or an elder law attorney for current figures.
How Community HealthChoices changed Pennsylvania's LTC system
Before 2018, Pennsylvania's long-term services and supports were delivered through several separate waiver programs: the Aging Waiver, the COMMCARE Waiver, the Independence Waiver, the Attendant Care Program, and the OBRA Waiver. Each operated under different rules, with different MCOs and different service packages.
Community HealthChoices (CHC), rolled out statewide by January 2020, replaced all of these with a single managed long-term services and supports (MLTSS) program. CHC serves dual-eligible individuals (those with both Medicare and Medicaid) and working-age adults with physical disabilities who receive Medicaid-funded personal care. The five CHC MCOs operate across five geographic zones — each zone has all five plans available, giving enrollees a real choice.
Enrolling in CHC: contact the Independent Enrollment Broker
What Pennsylvania long-term care Medicaid covers
- Nursing facility care (indefinite, once Medicare's 100-day benefit is exhausted and financial eligibility is met)
- Home health aide and personal care services through Community HealthChoices MCOs
- Adult day health services
- Participant-directed personal care — hire and direct your own care workers through CHC
- Respite care for family caregivers
- Home modifications and assistive technology
- LIFE program — all-inclusive day health services integrating Medicare and Medicaid (55+)
- Transportation to medical and day health appointments
- Medical equipment and supplies for home use
Pennsylvania operates Medicaid estate recovery — probate assets only