How to Apply for Community HealthChoices in Pennsylvania

Starting the Application Through the Independent Enrollment Broker

The application for Community HealthChoices does not go through the County Assistance Office first. It starts with the Pennsylvania Independent Enrollment Broker (PA IEB), currently operated by Maximus. You can begin the process by calling the IEB directly or by submitting a referral through the state's COMPASS online portal.

The IEB coordinates the entire enrollment sequence, which follows a rigid multi-step process that typically takes 8 to 12 weeks from first contact to active services. Here is what happens at each stage:

Step 1: Referral intake. You or a hospital discharge planner contacts the IEB. They schedule an in-person intake visit where the applicant currently lives — their home, a rehabilitation facility, or a hospital.

Step 2: First intake visit and physician certification. An IEB representative conducts the first in-person meeting. Simultaneously, the IEB sends a Physician Certification Form (MA-570 for home services, MA-51 for nursing facility placement) to the applicant's primary care physician. The physician must complete, sign, and return this form within 86 days.

This physician step is where most applications stall. The form must be signed by an MD or DO — physician assistants and nurse practitioners cannot sign it. If the physician's office is unresponsive, escalate early. Every week of delay is a week your parent may be paying out of pocket for care the waiver would cover.

Step 3: Functional eligibility determination. The IEB requests the local Area Agency on Aging to send an assessor for an in-home evaluation. The assessor conducts a Functional Eligibility Determination (FED) to determine whether the applicant meets the Nursing Facility Clinical Eligibility (NFCE) standard. This assessment evaluates the ability to perform daily activities — bathing, dressing, eating, toileting, transferring — and cognitive status.

Step 4: Financial eligibility. If the applicant is clinically eligible, the application moves to the County Assistance Office for income and asset verification. The 2026 thresholds: gross monthly income at or below $2,982, countable assets at or below $8,000 (or $2,400 if income exceeds the Special Income Limit). The CAO will request 60 months of bank statements to check for asset transfers during the lookback period.

Step 5: Plan selection. Once both clinical and financial eligibility are confirmed, the applicant selects one of three managed care organizations: AmeriHealth Caritas (marketed as Keystone First CHC in the Southeast zone), PA Health & Wellness, or UPMC Community HealthChoices. The IEB helps with plan comparison, but the choice belongs to the applicant.

Step 6: Service activation. The selected MCO assigns a service coordinator who develops a care plan based on the FED assessment. Services begin according to the care plan.

What the CHC Waiver Covers at Home

Community HealthChoices is not just nursing home coverage. The waiver funds a broad range of home and community-based services designed to keep your parent in their own home rather than in a facility:

• Personal assistance services — help with bathing, dressing, grooming, toileting, meal preparation, and light housekeeping
• Home health aides — hands-on personal care under a skilled care plan
• Adult day services — structured daytime programs with supervision, socialization, and personal care
• Home modifications — ramps, grab bars, stairlifts, bathroom modifications for wheelchair access
• Personal emergency response systems (PERS) — medical alert devices
• Home-delivered meals
• Specialized medical transportation (MATP)
• Participant-directed services — the ability to hire and direct your own care workers, including family members in some cases

The participant-directed option is a significant feature that distinguishes CHC from the LIFE (PACE) program. Under CHC's participant-directed model, the enrolled individual (or their representative) can hire, train, and supervise their own home care workers. Some families use this to pay a family member to provide daily care — something the LIFE program does not allow.

Common Mistakes That Delay Approval

Not having legal authority established. Without a signed durable power of attorney, an adult child cannot legally sign the application, access the parent's financial records for the CAO's lookback review, or execute the applicant signature section of the MA-51/MA-570. If your parent has cognitive decline, get the POA executed before starting the CHC application. Once capacity is gone and no existing legal representative is available, the family must petition the Orphans' Court division of the local Court of Common Pleas for guardianship under Chapter 55; the court must consider less-restrictive alternatives.

Incomplete financial documentation. The County Assistance Office requires 60 months of statements for every bank account, investment account, and retirement account. Missing statements from a closed account or an overlooked savings account will trigger a request for additional documentation, adding weeks to the process.

Assuming the physician will respond promptly. The 86-day deadline for the physician certification form sounds generous, but many applications expire because the form never comes back. Call the physician's office within two weeks of the IEB sending the form. If there is no progress by week four, ask the IEB about options for having another qualifying physician complete the evaluation.

The Full Application Roadmap

The Choosing Care in Pennsylvania guide includes an enrollment timeline tracker that maps every step of the CHC application with target completion dates, the specific forms needed at each stage, and the agency responsible. It covers the financial documentation checklist, the physician certification follow-up process, and how to choose between the three MCOs based on your parent's provider network and service needs.

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