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Understanding your care options
Paying for home care is often the first question families ask. Here is a plain-language explanation of how it generally works in Pennsylvania, and what our team can help with.
Important eligibility notice
Pennsylvania Medical Assistance may cover eligible home and community-based services for qualified individuals. Financial, functional, program, service, and authorization requirements apply. Our team can help explain the process, but eligibility and coverage cannot be guaranteed.
Plain language
How coverage generally works
Medical Assistance is Pennsylvania's Medicaid program. Some individuals who qualify may receive home and community-based services, which are supports delivered at home rather than in a facility.
Whether a person qualifies depends on several separate reviews. Financial requirements look at income and resources. Functional requirements look at the level of help a person needs with daily activities. Program requirements depend on which program a person is enrolled in, and services must be authorized before an agency can deliver them.
Those decisions are made by the Commonwealth and its assessment and enrollment partners — not by our agency. What we can do is explain the general process, tell you clearly what services we provide, and coordinate once services are authorized.
The general application process
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Contact the county or state intake line
Applications and eligibility screenings begin with the appropriate county assistance office or the state's enrollment and assessment partners.
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Complete financial and functional reviews
Both reviews are separate. One looks at income and resources; the other looks at the help a person needs day to day.
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Enrollment and service planning
If a person qualifies, a service plan is developed that lists the approved services and the amount authorized.
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Choose a provider and begin approved services
Once services are authorized, an approved provider can begin delivering the services listed in the plan.
Questions to have ready before you call
You do not need any of this to speak with us, but having it nearby makes the first conversations easier.
- Who needs care, and what kind of help is hardest right now?
- Does the person already receive Medical Assistance or any other benefits?
- Has anyone completed a needs assessment recently?
- Who else helps — family members, neighbors, other providers?
- What days and times would support be most useful?
- Is there a case manager, service coordinator, or county contact already involved?
Payment options
Payment paths depend on the programs and arrangements that apply to each client. Call or email our team and we can explain the options our agency currently works with and what information is usually needed to get started.
We do not publish rates, coverage promises, or approval timelines that we cannot verify.
Questions
Common questions about payment
No agency can determine eligibility. That decision is made through the Commonwealth's review process. We can explain the general steps and what information is usually requested.
Timelines vary by program and by individual circumstances. We do not estimate approval dates, because we do not control the review process.
Call us anyway. We can explain the payment options our agency accepts and talk through what a smaller schedule of support might look like.
Please do not send financial records, Medicaid identification numbers, or Social Security numbers through the website. If documentation is needed later, we will tell you exactly where it goes and how to send it safely.
Talk it through with our team
We will explain what we know, tell you plainly what we do not decide, and help you find the right office to call.