Help in the Home Assessment for EligibilityAssessment for Eligibility
PCA completes a thorough in-person level-of-care assessment using the state-mandated Functional Eligibility Determination (FED) Tool for individuals 60 years and older and for individuals 18 years and older who are interested in the long-term care services, which include the following:
Home-based Care
- Act 150 Attendant Care Program (for individuals between 18 and 59 years old)
- Community HealthChoices (CHC)
- Living Independence for the Elderly (LIFE)
- OPTIONS program
Community and Residential Care
- Domiciliary Care (Dom Care) program
- Medical Assistance (Medicaid) Nursing Facility services
Personal Care Home (PCH)
The assessment tool helps to determine a level of care that focuses on the person’s functional abilities. Based on the individual’s responses, one of two assessment outcomes is determined: 1) Nursing Facility Ineligible (NFI), where the individual may need assistance but not to the level of someone residing in a nursing facility, or 2) Nursing Facility Clinically Eligible (NFCE), where the individual needs assistance that reaches the level of someone residing in a nursing facility.
A level of care assessment is one of the steps in determining eligibility for long-term care services. Individuals must meet both functional and financial eligibility to receive long-term care services. There is no cost for the assessment, and they are not obligated to enroll in any service upon the completion of a FED.
The Enrollment Process
The enrollment process for Community HealthChoices (CHC) and Living Independence for the Elderly Program (LIFE) are facilitated by the Pennsylvania Independent Enrollment Broker (PA IEB), a contracted statewide entity for Pennsylvania residents. During the assessment process, a referral alert will be sent to the PA IEB requesting assistance for individuals interested in proceeding with the enrollment process for CHC or LIFE program.
For more information on the application and enrollment process for the above home and community-based services, please visit https://paieb.com/en/apply-for-waiver-services.
What is Community HealthChoices?
Community HealthChoices (CHC) is Pennsylvania’s long-term services and supports managed care program for individuals who have both Medicaid and Medicare. CHC helps eligible individuals access long term services and supports (LTSS) to perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.
To qualify for the CHC program participants must:
- Be age 21 or older
- Be a Pennsylvania resident
- Be a U.S. citizen or lawful resident
- Meet the level of care needs for a skilled nursing facility
- Meet income and asset requirements
For more information, please visit https://www.pa.gov/services/dhs/apply-for-community-healthchoices.html.
What is Living Independence for the Elderly (LIFE) program?
Living Independence for the Elderly (LIFE) program is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet their health and personal needs.
LIFE is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services including primary care services & specialist services. The program is known nationally as the Program of All-Inclusive Care for the Elderly (PACE). All PACE providers in Pennsylvania have “LIFE” in their name.
To be eligible for LIFE, participants must:
- Be age 55 or older
- Meet the level of care needs for a skilled nursing facility or a special rehabilitation facility
- Meet the financial requirements as determined by their local County Assistance Office or be able to privately pay
- Reside in an area served by a LIFE provider
- Be able to safely be served in the community as determined by a LIFE provider
For more information, please visit https://www.pa.gov/agencies/dhs/resources/aging-physical-disabilities/life.html.
What is the OPTIONS program?
OPTIONS is a program that allows individuals to receive services and supports in their homes and communities. Funded primarily through the Aging Block Grant, the OPTIONS Program serves individuals who are either functionally or financially ineligible for Medical Assistance (Medicaid) Long-Term Services and Supports, such as Community HealthChoices (CHC) or Living Independence for the Elderly (LIFE) program. OPTIONS services are provided to eligible older adults age 60 and older to assist them in maintaining independence at the highest level of functioning in the community. These services include personal care support for daily activities (such as bathing, dressing, and grooming), older adult daily living services, home-delivered meals, and home modifications and accessibility adaptations. Additionally, OPTIONS provides medical equipment and supplies. All other financial resources (individual, local, state and/or federal) will be considered and utilized before OPTIONS services are provided.
To qualify for the OPTIONS program, participants must:
- Be age 60 or older
- Be a Pennsylvania resident
- Be a U.S. citizen or lawful permanent resident
- Require some degree of assistance in regard to physical and/or mental status that impacts daily functioning