Community HealthChoices Eligibility Pennsylvania 2026: Income, Assets, and How to Apply

Community HealthChoices is Pennsylvania's Medicaid managed care program for long-term services and supports. If your parent needs ongoing in-home care, nursing facility coverage, or community-based services funded by Medicaid, this is the program they will be enrolled in.

The eligibility rules changed for 2026. Here is exactly how they work.

The 2026 Financial Limits

Pennsylvania uses a two-tier asset system that catches many families off guard. The income limit is the same for both tiers, but the asset limit shifts based on where the applicant's income falls.

Income limit: $2,982 per month (gross). This is 300% of the 2026 Federal Benefit Rate.

Tier One asset limit — $8,000. Applies when the applicant's gross monthly income is at or below $2,982. This includes a Pennsylvania-specific $6,000 resource disregard on top of the $2,000 federal minimum.

Tier Two asset limit — $2,400. Applies when the applicant's income exceeds $2,982. The $6,000 state disregard disappears, dropping the countable asset ceiling to $2,400.

The primary home is exempt from asset calculations up to a home equity limit of $752,000, as long as the applicant intends to return home or a spouse still lives there.

Spousal Protections

When one spouse needs nursing facility or in-home care and the other remains in the community, federal spousal impoverishment rules prevent the community spouse from being left destitute.

Community Spouse Resource Allowance (2026):

• Minimum: $32,532
• Maximum: $162,660

The community spouse can keep at least $32,532 in countable assets — and potentially up to $162,660 depending on the couple's total resources at the time of the institutionalized spouse's application.

Monthly Maintenance Needs Allowance (2026):

• Minimum: $2,705.00 per month
• Maximum: $4,066.50 per month

This ensures the community spouse retains enough of the couple's income to cover basic living expenses. If the community spouse's own income falls below the minimum, they can receive a portion of the institutionalized spouse's income to bridge the gap.

Clinical Eligibility

Financial eligibility alone does not qualify an applicant. The CHC program requires a clinical determination that the applicant needs a nursing facility level of care — even if the goal is to receive services at home.

The assessment process has three stages:

1. Referral to the PA Independent Enrollment Broker (IEB) — managed by Maximus. Contact: 1-877-550-4227. The IEB coordinates the intake.

2. Physician certification — the applicant's doctor completes Form MA 51, documenting diagnoses, medication needs, and professional care requirements. This must be returned within five business days.

3. Functional Eligibility Determination (FED) — conducted in-person by the local Area Agency on Aging within ten business days of the home visit. The assessment uses the InterRAI Homecare Assessment Tool and evaluates five areas: cognition, mood/behavior, functional status (ADLs), continence, and treatments/procedures.

To qualify clinically, the applicant must show either one full deficit (such as being bedbound or having severe cognitive impairment) or partial deficits in at least three activities of daily living — bathing, dressing, eating, toileting, transfers, or mobility.

The Three Managed Care Organizations

Once approved, the enrollee chooses one of Pennsylvania's three CHC managed care organizations:

• AmeriHealth Caritas Community HealthChoices (operating as Keystone First CHC in southeastern Pennsylvania)
• Pennsylvania Health & Wellness
• UPMC Community HealthChoices

The selected plan assigns a service coordinator who develops a Person-Centered Service Plan — this plan specifies the authorized hours for personal care, home modifications, adult day services, and other covered supports. If the enrollee wants a different plan, Pennsylvania says a CHC MCO may be changed at any time.

How to Apply

The application is filed through the County Assistance Office using Form PA 600L (the Medical Assistance application). You can apply online through the COMPASS portal, by mail, or in person at the local county office.

Gather these documents before applying: five years of bank statements, investment account records, property deeds, vehicle titles, life insurance policies, and any documentation of gifts or asset transfers. The 60-month lookback audit is thorough, and missing documents cause delays that can extend the unpaid-care window at a nursing facility.

The Pennsylvania Hospital Discharge Guide includes a financial documentation checklist and Medicaid application timeline designed to get through the County Assistance Office process without delays that create filial liability exposure.

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