OPTIONS Program Sliding Scale Copay PA

How the Sliding Scale Works

The OPTIONS program — sometimes called "Help at Home" — is Pennsylvania's state-funded home care program for adults 60 and older who need help with daily functioning and are either clinically or financially ineligible for Medicaid. Unlike Community HealthChoices, OPTIONS has no hard income or asset cap. Instead, it uses a sliding-scale copay structure tied to the Federal Poverty Level (FPL).

Free services (0% copay): Participants with household incomes at or below 133% of the FPL pay nothing. For 2026, that translates to single applicants earning under roughly $1,669 per month, and married couples under approximately $2,265 per month.

Sliding-scale copay: Participants with incomes between 134% and 300% of the FPL contribute a percentage of care costs that increases with income. The exact copay amount is calculated by your local Area Agency on Aging based on documented income.

Full cost or phase-out: Financial assistance phases out completely for single applicants earning over approximately $3,765 per month and married couples above about $5,110 per month. Above those thresholds, the participant pays 100% of service costs if they choose to continue receiving services through the AAA.

There are no asset limits at any income level. Your parent's savings, home equity, or investment accounts do not affect eligibility or copay calculations. This is a fundamental difference from Medicaid, where asset limits of $8,000 or $2,400 apply.

The $765 Monthly Care Plan Cap

OPTIONS imposes a strict monthly care plan cost cap of $765. This limits how much the AAA can spend on hands-on care services for each participant per month.

At Pennsylvania's median home care rate of about $34 per hour, $765 buys roughly 22 hours of personal care assistance per month — about 5 hours per week. That's enough for a few bathing and grooming sessions plus some meal preparation, but it won't cover full-time daily support.

The critical detail families miss: certain essential services are explicitly excluded from the $765 cap. These include:

• Home-delivered meals
• Home safety modifications (ramps, grab bars, stairlifts)
• Specialized medical transport
• Care management and assessment services
• Adult protective services

This exclusion is strategically important. It means the AAA can provide eligible home modifications, deliver daily meals, and provide care management visits without those costs exhausting the $765 limit allocated for hands-on personal care. For a parent with moderate functional needs, the combination of capped personal care hours plus meals and home modifications can help delay a move to facility care.

How to Apply

OPTIONS is administered locally by Pennsylvania's 52 Area Agencies on Aging, and the application process starts with a call or visit to your parent's local AAA.

The AAA conducts a Needs Assessment using the state's standardized tool, which evaluates ADL and IADL capacity, cognitive status, and home safety. The assessment generates a Needs Assessment Score (NAS) that quantifies functional deficits and prioritizes enrollment.

For the assessment, your parent must be at least 60 years old, a Pennsylvania resident, and a U.S. citizen or lawful permanent resident. Contact the AAA directly to confirm what documentation it requires.

Waitlists and Priority

Because OPTIONS is funded through the state's Aging Block Grant rather than being a federal entitlement, individual AAAs can and do maintain waiting lists when demand exceeds their allocated budget. Priority is assigned based on functional need (higher NAS scores rank first), with one categorical override: individuals requiring home-delivered meal services are placed at the top of the waiting list by state mandate.

If your parent is on a waitlist, ask the AAA for a projected wait time and whether any of the cap-excluded services (especially meals and home modifications) can be started immediately while waiting for personal care hours to open up.

The Mandatory Medicaid Referral

One rule catches families off guard: if an OPTIONS participant appears to be both functionally and financially eligible for Medicaid, the AAA must initiate the Mandatory MA Eligibility Determination Process. This means the AAA will assist your parent in applying for Community HealthChoices.

If your parent refuses to cooperate with the Medicaid application, they can be discharged from OPTIONS or required to pay 100% of care costs out of pocket. This policy exists because Medicaid is federally funded while OPTIONS uses state block grant money — the state requires participants to access federal funding first when they qualify.

For families whose parent likely qualifies for Medicaid, this isn't a penalty — it's an upgrade. CHC provides broader services at no copay. The mandatory referral just accelerates a transition that benefits the participant. But for families who've strategically avoided Medicaid (to protect assets from estate recovery, for instance), this referral requirement is something to plan around.

The Pennsylvania Care Decision Guide covers both the OPTIONS and CHC pathways in detail, with worksheets for calculating which program best fits your parent's financial and clinical situation.

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