Pennsylvania Independent Enrollment Broker: Your Gateway to Community HealthChoices

If your parent needs Medicaid-funded home care or long-term-care services through a Community HealthChoices pathway in Pennsylvania, the process runs through the Pennsylvania Independent Enrollment Broker. The PA IEB — managed by Maximus — is the statewide intake entity that coordinates clinical eligibility assessments and enrolls approved applicants into Community HealthChoices managed care plans.

Understanding what the PA IEB does, and when to contact them, can shave weeks off the timeline between a hospital discharge and receiving in-home services.

What the PA IEB Does

The PA IEB coordinates three functions in the waiver enrollment process:

1. Clinical eligibility coordination — managing the dual-track assessment that determines whether an applicant meets the Nursing Facility Clinically Eligible (NFCE) standard
2. Financial application assistance — conducting an in-person home visit to help applicants complete the Medicaid long-term care application
3. MCO enrollment — once eligibility is confirmed, assisting the applicant in choosing one of the three Community HealthChoices managed care organizations

The PA IEB does not determine financial eligibility — that decision stays with the County Assistance Office through the COMPASS application. But the clinical and financial tracks run simultaneously, and the PA IEB coordinates the clinical side.

The Assessment Pipeline

Step 1: Referral

Anyone can make a referral to the PA IEB — the patient, a family member, a hospital discharge planner, a physician, or a social worker. Contact the PA IEB at 1-877-550-4227 (TTY: 711).

The referral captures basic information: the applicant's name, date of birth, current location, medical conditions, and the type of services needed (nursing facility, home and community-based waiver, or both).

Step 2: Physician Certification (Form MA 51)

Within days of the referral, the PA IEB sends Form MA 51 (Medical Evaluation Plan of Care) to the applicant's attending physician. The physician must document:

• Active medical diagnoses
• Current medications and treatment requirements
• The patient's functional limitations in activities of daily living
• A professional certification that the patient requires a level of care exceeding room and board

The completed form must be returned to the PA IEB within five business days. This is where hospital discharge timelines create pressure — if the patient is being discharged and the attending physician hasn't completed the MA 51, the clinical assessment stalls.

Step 3: In-Person Home Visit

Within seven business days of the referral, a PA IEB representative visits the applicant's home to assist with the financial Medicaid application. This visit helps the family gather the documentation needed for the County Assistance Office application — income verification, asset records, and the five years of financial history required for the lookback review.

Step 4: Functional Eligibility Determination (FED)

Within ten business days of the home visit, an assessor from the local Area Agency on Aging conducts an in-person functional assessment. The assessment uses version 10 of the InterRAI Homecare Assessment Tool, evaluating five clinical areas:

• Cognition — memory, decision-making, orientation
• Mood and Behavior — depression, anxiety, behavioral symptoms
• Functional Status — assistance needed for bathing, dressing, eating, toileting, transfers, mobility
• Continence — bladder and bowel control
• Treatments and Procedures — wound care, injections, oxygen, dialysis

To qualify as Nursing Facility Clinically Eligible, the assessment must document either a full deficit in at least one area (severe cognitive impairment, bedbound status) or partial deficits in at least three activities of daily living.

After Approval: Choosing an MCO

Once the PA IEB confirms clinical eligibility and the County Assistance Office approves financial eligibility, the applicant must choose one of three Community HealthChoices managed care organizations:

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

The PA IEB provides plan comparison materials and enrollment assistance. If the applicant doesn't actively choose within the enrollment window, the system auto-assigns a plan — which may not have the best provider network for the applicant's location.

Each MCO assigns a service coordinator who develops the Person-Centered Service Plan, authorizing specific services: personal care hours, home modifications, durable medical equipment, adult day services, and respite care. Families who want to self-direct care can request Services My Way through the service coordinator.

Timing the Referral

The most common mistake families make is waiting until the parent is already in crisis to contact the PA IEB. The full assessment pipeline — physician certification, home visit, functional assessment, financial determination — takes several weeks under normal conditions. Hospital discharge timelines run in days.

If your parent is in the hospital and you anticipate needing long-term care services after discharge, call the PA IEB on the first day. Running the clinical assessment concurrently with the hospital stay means services can begin sooner after discharge rather than weeks later.

The Pennsylvania Hospital-to-Home Guide maps the PA IEB assessment timeline against the hospital discharge and Medicaid application processes, so families can track all three tracks in parallel and know exactly which steps need to happen when.

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