In-Home Dementia Care in Pennsylvania

Paying for care in Pennsylvania: Community HealthChoices

Medicare does not pay for the long-term help dementia requires. In Pennsylvania the programme that can is CHC, administered by the Pennsylvania Department of Human Services, through three managed care organizations covering five CHC zones.

Who qualifies

CHC is for people 21 and older who either have both Medicare and Medicaid, receive Medicaid long-term services and supports, or live in a Medicaid-funded nursing home. Clinical eligibility rests on needing help with everyday personal tasks at a nursing-facility level of care. The cited page does not describe any dementia-specific eligibility route, so ask the office that administers the programme how a dementia diagnosis is weighed in that assessment.

The financial limits

Single applicant

Not published on the state CHC program page; set by Pennsylvania Medicaid financial eligibility rules

Married couple

Not published on the state CHC program page; spousal impoverishment rules apply

Look-back period

Not published on the state CHC program page; standard Medicaid transfer-of-asset rules apply

How to apply

Apply online through COMPASS or at a county assistance office. Once financially eligible, the person is enrolled with one of the three CHC managed care organizations in their zone, which coordinates their long-term services and supports.

What is unusual about Pennsylvania

CHC is mandatory managed care: rather than a standalone waiver you enroll in, long-term services and supports are delivered through an MCO that also coordinates your physical health care, so one plan covers both.

Rules and figures change. Confirm the current position with the programme itself before making a financial decision.