Home and Community-Based Services Waiver
Under this program, home and community-based long-term care services can be provided as an alternative to nursing home care. It is called a "Waiver" program because services are funded through a special waiver of certain Medicaid restrictions, allowing payments typically used for nursing home care to be used for in-home services.
To be eligible for CHC Waiver, you must:
- Be a resident of Pennsylvania
- Be a U.S. citizen or a qualified Non-citizen
- Have a Social Security Number
- Be 21 years of age or older
- Income and resource eligible
- Meet the required level of care for a nursing facility
Effective 4/1/16, Maximus, the PA Independent Enrollment Broker (IEB), handles the enrollment process for all of the Waiver programs.
Click here for the Steps to Apply for Waiver: www.paieb.com/doc/StepsToApply.pdf
Click here for a printable referral form: www.paieb.com/doc/PAIEBReferralForm.v2.pdf
There are several ways that you can make a referral to Maximus:
Participant Help Line can be reached by calling 1-800-757-5042.
Once you are approved for the CHC Waiver Program, the Managed Care Organization (MCO) you select during the enrollment process will contact you to begin service.
If you are determined to be eligible, the following services may be available at no cost to you, enabling you to live more comfortably at home:
- Adult Daily Living Services
- Assistive technology
- Behavior therapy
- Benefits counseling
- Career assessment
- Cognitive rehabilitation therapy
- Community integration
- Community transition services
- Employment skills development
- Financial management services
- Home adaptations
- Home delivered meals
- Home health aide
- Home health-nursing
- Job coaching
- Job finding
- Non-medical transportation
- Nutritional counseling
- Participant-directed goods and services
- Participant-directed community supports
- Personal assistance services
- Personal emergency response system (PERS)
- Pest eradication
- Residential habilitation
- Service coordination (including information and assistance in support of participant direction. Service coordination is furnished as a distinct activity to waiver participants as an administrative activity)
- Structured day habilitation
- Vehicle modifications
EXTENDED STATE PLAN SERVICES
- Home health-physical, occupational, and speech and language therapies
- Specialized medical equipment and supplies
Once you are enrolled in the CHC Waiver Program, you will be assigned a Service Coordinator. An individual service plan is developed jointly by you and the Service Coordinator, after which services are authorized. You will then be able to choose any company or agency from a list of participating providers. All service providers are certified by the Pennsylvania Department of Human Services (DHS) to ensure that they meet Medicaid standards.
There are no cost sharing or contributions for CHC Waiver participants. However, you may be subject to Medical Assistance (MA) Estate Recovery http://www.dhs.pa.gov/citizens/estaterecoveryprogram/#.VzUHuZjD-Uk
In order to qualify for CHC Waiver Services, you must meet eligibility requirements. This includes a level of care assessment and a determination of financial eligibility.
To view a flow chart showing the steps to Applying for Medicaid Funded Home Care when a referral is made to COSA first, click here.