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How to Get Medicaid Coverage for Home Care in Pennsylvania

It surprises some people to learn that Medicaid pays for in-home care for seniors. Each state establishes its own rules for its Medicaid plan according to the federal guidelines. We’ll detail how the Medicaid home care programs work in Pennsylvania, review the qualifications, and explain how the program pays for care.

Medicaid Programs in Pennsylvania

There are three different types of Medicaid Assistance programs in Pennsylvania for senior citizens.

Here’s a brief description of each:

  1. Nursing home and institutional care – all eligible individuals receive funding and care and it’s only provided in nursing homes.

  2. Home and Community-Based Services/Medicaid Waivers – provides in-home, adult daycare, or assisted living services. This program limits the number of enrollees, so there may be a waiting list.

  3. Standard Medicaid/Services for the aged blind and disabled – entitles qualified individuals to services for in-home or adult daycare.

Medicaid’s Home Care Programs

The federal government established Medicaid as a joint program with states to provide health insurance to seniors, people with disabilities, and children from low-income families or guardians. For those who qualify, it also covers nursing home care.

It’s common for states to offer waiver programs under Medicaid for in-home and community-based services for those who prefer to receive care in the comfort of their homes.

Every state’s Medicaid home care program is different because of the different demographics of people in each state. States establish their own requirements for income and assets, and they determine what services they will provide.

Eligibility for the Pennsylvania Medicaid Program

The requirements for the Medicaid Assistance in Pennsylvania are straightforward, and they are as follows:

  • You must be a resident of the state of Pennsylvania

  • You must be a United States national, permanent resident, citizen, or legal alien who needs health care assistance or insurance

  • You must have low or very low income

In addition, you must be meet one of the following circumstances:

  • Be pregnant

  • Be responsible for a child age 17 or younger

  • Have a disability

  • Have a family member in the household with a disability

Medicaid Assistance in Pennsylvania:

Qualifying for Medicaid is important because if you qualify for Medicaid and Medicare you can participate in the Community HealthChoices (CHC) program which is a Medicaid-managed program through Medicaid for individuals who are age 21 or older who require a nursing home level of care.

Seniors and individuals with physical disabilities can get long-term support services through CHC to help them live independently at home. It’s mandatory for people who meet CHC requirements to enroll in the program. Qualified enrollees can get help with personal care and activities of daily living.

Get Medicaid Coverage for Care at Home

The state of Pennsylvania set limits for income and assets for single people and married people where one or both spouses are applying for Medicaid.

The types of services Medicaid’s home care program in Pennsylvania includes the following:

  • In-home caregivers

  • Personal care services (bathing, eating, mobility, etc.)

  • Light housekeeping (vacuuming, laundry, shopping, etc.)

  • Respite for caregivers

  • Minor home modifications for accessibility

  • Medical equipment

Family members can get paid to care for a Medicaid recipient in most states, including Pennsylvania. When enrolling in Medicaid, the applicant simply selects a program that allows them to choose their own caregiver. This is called “consumer-directed care.”

In some states, legal guardians and spouses qualify as family caregivers under the Medicaid program. Other states will only pay family caregivers if they don’t live in the same household as the person receiving Medicaid.

How Much Does Medicaid Pay for Home Health Care in Pennsylvania?

Medicaid Assistance pays a standard hourly rate for caregivers under the consumer-directed services plan. Generally, the rate is a few dollars per hour lower than what private caregivers demand.

Pennsylvania residents can expect to pay $21 per hour for a family caregiver aid through the Medicaid CHC program. That amounts to an annual cost of $21,840 for a caregiver that provides services for 4 hours each day, 5 days a week.

The picture for family caregivers who are paid by Medicaid looks very different in various states than in Pennsylvania. While the qualifications and rules are different depending on where you live, most states provide some type of assistance for seniors who want to take advantage of a family caregiver and ensure the caregiver gets paid for their services.

If you’re looking to become a family caregiver for a beloved family member, reach out to us at

Abington Caregivers. Our expert staff will help you understand the Medicaid process and guide you through the steps. Call us today at (215) 600-3434 for more information.

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