In-Home Respite Services: Temporary care in the client’s home, assisting with activities of daily living (ADLs) and instrumental activities of daily living, and supervision.
Long Term Services and Supports
• Personal Hygiene Care (non-medical assistance):with eating, bathing, incontinence/continence toileting, etc.
• Homemaker Services: assistance with housecleaning and doing laundry, preparing meals, etc.
• Medication Administration & Management
• Respite Care: in-home and out-of-home short-term care
to alleviate a primary caregiver
• Supported Employment: job coaching services
• Career Assessment
• Job Finding
• Benefits Counseling
• Counseling Services
• Community Integration: skills training for community living
• Assistive Technology: devices & services to improve functioning
• Adult Day Health Care/ Adult Daily Living: provides daytime supervision and personal care assistance in a group setting
• Home Modifications
• Home Meal Delivery
• Transportation (non-medical)
1. Residency
• Must be a resident of Pennsylvania.
2. Age or Disability Requirements
• Age 21 or older and eligible for Medicaid.
• Or, age 18 or older and eligible for both Medicaid and Medicare (*dual eligible).
3. Need for Long-Term Services and Supports (LTSS)
• Must meet the criteria for needing a nursing facility level of care as determined by the state's standardized assessment process.
• Individuals with physical disabilities who are unable to perform daily activities independently often qualify.
4. Income Eligibility
• Must meet Medicaid financial eligibility requirements.
• Income limits: Medicaid income limits vary based on household size and other factors.
• Generally, income should not exceed approximately 300% of the Federal Benefit Rate (FBR). In 2023, this is around $2,742/month for a single individual.
• Asset limits: Typically, a maximum of $2,000 in countable assets for a single individual. Certain assets, such as a primary home and a vehicle, may be exempt.
5. Medicaid Eligibility
Must qualify for Medicaid (*Medical Assistance) or be dually eligible for both Medicaid and *Medicare.
6. Enrollment in a CHC Plan
Must be a willing *Participant in the CHC LTSS program administered by CHC MCOs under contracts with *PA DHS.
7. Functional Eligibility
Must undergo a functional needs assessment to determine eligibility for LTSS. This assessment is typically conducted by the *Independent Enrollment Broker (IEB) or *County Assistance Office, who
evaluates the applicant's ability to perform daily activities like bathing, dressing, mobility, and cognitive functions.
8. Willingness to Participate in HCBS
The applicant must be willing to receive and participate in community-based services rather than opting for institutional care (such as in a nursing home).
9. Target Population
Individuals who are dual-eligible or those who qualify for Medicaid long-term care services and who wish to remain in the community.
10. Not Currently Receiving Similar LTSS
Applicants must not be receiving similar LTSS services from other Pennsylvania Medicaid programs or HCBS waivers unless transitioning to CHC for LTSS.
11. Plan of Service Requirement
Once enrolled, a *person-centered service plan is developed, which outlines the services the individual will receive in the community. This plan ensures the individual's needs are met in a home-based
setting rather than institutional care.