Home Care vs. Home Health in Pennsylvania: 2026 Cost, Coverage, and How to Choose

The single most important fact about in-home care in Pennsylvania, and the one that costs families thousands of dollars when they get it wrong, is that "home care" and "home health care" are two different services governed by two different chapters of 28 Pa. Code and paid for by two different sets of funders. Non-medical home care, the aide who comes in to help your mother bathe and dress and prepare meals, is licensed under 28 Pa. Code Chapter 611 as a Home Care Agency or Home Care Registry. Medicare-certified home health, the registered nurse and physical therapist who come in after a hospital stay, is licensed under 28 Pa. Code Chapter 601 and must additionally meet the federal Conditions of Participation at 42 CFR Part 484. The same company can hold both licenses, but they are independent licenses with independent surveys, independent scopes of practice, and entirely different payer rules. Medicare pays for one and not the other. PA Medicaid pays for both but through different mechanisms. Long-term care insurance, the VA, and OPTIONS each treat the two services differently. This guide walks through the licensing, the funding, and the practical choice a Pennsylvania family has to make when a parent needs help at home.

In 2026, non-medical home care in Pennsylvania is a significant private-pay expense that varies by region, while Medicare-certified home health is zero cost to the patient when eligibility tests are met. The PA Medicaid program, Community HealthChoices, pays for both kinds of services for nursing-facility-clinically-eligible adults age 21 and over, but it routes them through different parts of the benefit package. The federal HCBS Access Rule that took effect in 2024 is reshaping how PA pays home care agencies through 2030. And the Jimmo v. Sebelius settlement, twelve years old now, still has not fully penetrated the day-to-day operations of the home health industry, which means PA families are routinely told "Medicare won't cover this anymore" when in fact it should.

By Brevy Care Team

The fundamental distinction

Non-medical home care and Medicare-certified home health both put a person in your home. From the family's vantage point, both look like an "aide" or a "caregiver" walking through the door. The legal, regulatory, and financial gap between the two is enormous.

Non-medical home care is delivered by a personal-care aide or companion. The aide is unlicensed. The agency holds an HCA or HCR license under 28 Pa. Code Chapter 611. The aide does activities of daily living (ADLs) like bathing, dressing, transferring, toileting, and feeding, plus instrumental ADLs like meal preparation, light housekeeping, laundry, and transportation. The aide can remind a resident to take medications and can watch them take them, but in most cases cannot put a pill in the resident's mouth. Medicare does not pay for this service.

Medicare-certified home health is delivered by a multi-disciplinary team of licensed clinicians. Registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists, and medical social workers visit the home under a physician-authored plan of care. The agency holds a PA HHA license under 28 Pa. Code Chapter 601 and is also Medicare-certified under 42 CFR Part 484. Medicare pays the entire bill when the patient is homebound, has a skilled need (intermittent nursing, PT, or speech therapy), is under physician orders, has a face-to-face encounter on file, and is being served by a Medicare-certified agency. There is no copay, no deductible, no time limit, and no lifetime cap. Durable medical equipment ordered through the home health agency carries the standard 20% Part B coinsurance, but that is the only out-of-pocket cost.

Medicare home health does include a home health aide benefit, but the aide is adjunctive to the skilled need. When an RN is on the case for wound care twice a week, the plan of care can include one to three hours of aide time two to five visits per week, in support of the skilled need. Once the skilled need resolves, the aide visits end. Families who think Medicare will send a daily eight-hour aide because Mom has memory loss are misreading the benefit. That volume of care is non-medical home care territory.

How Pennsylvania licenses non-medical home care

The statute is the Health Care Facilities Act, Article VIIIa, "Home Care Agencies and Home Care Registries," at 35 P.S. §§ 448.801a et seq., enacted by Act 69 of 2006 and made operationally enforceable on April 12, 2009. The implementing regulation is 28 Pa. Code Chapter 611. The license-issuing authority is the PA Department of Health Division of Home Health under the Bureau of Health Care Quality Assurance.

Chapter 611 defines two distinct license categories. A Home Care Agency (HCA) employs caregivers as W-2 employees, schedules them, supervises them, and dispatches them to clients. The agency is the legal employer and carries worker's compensation. The vast majority of PA non-medical home care is delivered by HCAs. A Home Care Registry (HCR) is a referral service that matches independent self-employed caregivers with clients. The registry does not employ the caregivers, who operate as 1099 contractors. The registry's regulatory burden is lighter than an HCA's, but families using a registry assume more direct responsibility for taxes, supervision, and worker's comp. Some older PA materials reference a third category called Home Care Services Agency (HCSA), but in 2026 that term is legacy, and the operative license class for the dominant model is HCA.

What an HCA aide can and cannot do

The bright line that confuses families more than any other is the medication question. A Chapter 611 aide may bathe, dress, transfer, toilet, feed, and ambulate the client. They may do meal preparation, light housekeeping, laundry, errands, transportation if the agency carries the right insurance, companionship, and supervision. They may "remind" or "cue" a resident to take medications, can hand the resident a pre-filled pill organizer, and can observe the resident self-administer.

What the aide may not do, absent specific RN delegation under the PA Nurse Practice Act, is administer medications. They cannot put pills in the resident's mouth. They cannot draw up or administer insulin. They cannot do wound care beyond the simplest dressing on a stable wound. They cannot manage catheters, G-tubes, J-tubes, or tracheostomies. Anything that requires clinical judgment is outside scope. PA families paying $32 per hour are sometimes shocked to learn that their aide can sit and watch Mom take her morning pills but cannot place the pills in her mouth. The workarounds are a personal care home setting where med-pass aides are trained, a Medicare home health RN visit if a skilled need exists, or a family member doing the actual administration.

Mandatory caregiver clearances

Every direct-care worker an HCA assigns must clear pre-employment screening that includes a Pennsylvania State Police Criminal History Record (PATCH), an FBI fingerprint-based background check (required for any caregiver who has lived outside Pennsylvania within the prior two years), a PA Child Abuse Clearance under 23 Pa. C.S. § 6344, an Older Adults Protective Services Act review, tuberculosis testing, and a competency evaluation appropriate to the tasks assigned. The 1997 OAPSA lifetime ban on direct-care work after certain convictions was struck down as unconstitutional in Peake v. Commonwealth (2015), so PA now uses a more nuanced individualized review framework, but the screening itself is non-negotiable. A family asking an agency to produce paperwork on its caregivers' clearances should expect documentation, not vague reassurances.

How Pennsylvania licenses Medicare-certified home health

The PA regulation is 28 Pa. Code Chapter 601, "Home Health Care Agencies," administered by the same PA DOH bureau. The dominant rulebook, however, is the federal Conditions of Participation at 42 CFR Part 484. Most of Chapter 601's substantive provisions cross-reference or defer to the federal CoP because Medicare certification is what gives the HHA its commercial model.

The 42 CFR Part 484 rulebook covers patient rights (§ 484.50), the comprehensive assessment (§ 484.55), care planning (§ 484.60), quality assessment and performance improvement (§ 484.65), infection prevention (§ 484.70), skilled professional services (§ 484.75), home health aide services (§ 484.80), clinical records (§ 484.110), and personnel qualifications (§ 484.115).

For a Medicare beneficiary to be eligible for home health, the patient must be confined to the home (the homebound test, which is functional, not strictly literal), need intermittent skilled nursing or therapy, be under physician or authorized non-physician practitioner orders, have a documented face-to-face encounter on file, have a plan of care reviewed at regular intervals, and receive services from a Medicare-certified HHA. When all six tests are met, Medicare pays the full bill.

The 2026 PA home health market

The Pennsylvania home health agency market has consolidated significantly since 2020. The cumulative effect of Patient-Driven Groupings Model (PDGM) payment cuts through CY 2023, CY 2024, CY 2025, and CY 2026 Final Rules has put net pressure on agency margins even as the workforce has driven up labor costs.

National chains with significant PA presence include BAYADA Home Health Care (the largest non-Medicare home care provider in PA by census, headquartered in Moorestown, NJ), Encompass Health Home Health (now Enhabit), Amedisys, LHC Group, Aveanna, Interim, and AccentCare. Health-system-affiliated HHAs (UPMC Home Healthcare, Penn Medicine at Home, Geisinger at Home, AHN Healthcare@Home, St. Luke's Visiting Nurses, Lehigh Valley Home Care) are the dominant pipeline from acute hospitals to in-home care. Independent local HHAs continue to operate in many counties, particularly outside the Philadelphia and Pittsburgh metros, but they are increasingly vulnerable to PDGM rate pressure and many have sold to consolidators.

Geographic gaps matter. Counties in the Northern Tier (Tioga, Bradford, Sullivan, Susquehanna, Wayne) and the Northwest (Forest, Cameron, Elk, Potter, McKean) often have only a handful of HHAs serving them. Travel-time-driven LUPA risk and labor-market shortages combine to keep capacity thin.

The 80/20 rule and what it means for PA families

The single most important federal regulatory development affecting PA home care between 2026 and 2030 is the Ensuring Access to Medicaid Services Final Rule. The rule is referred to as the HCBS Access Rule, CMS-2442-F, or the "80/20 rule" after its single most consequential requirement: that at least 80% of Medicaid HCBS payments for personal care services, home health aide services, and homemaker services flow to direct-care worker compensation, with the remaining 20% covering training, administration, and supervision.

The 80% pass-through requirement does not become enforceable until July 9, 2030, six years after publication. Earlier compliance milestones (HCBS access reporting, person-centered service plan alignment, beneficiary advisory restructuring, critical incident reporting) are phasing in between 2025 and 2027. PA OLTL has begun adjusting Community HealthChoices personal assistance services rate floors through MCO directed payments, and the FY 2025-2026 budget included rate-floor increases. For families, the practical implications are three. First, hourly rates will keep rising through 2030. Second, some agencies, particularly those operating on thin CHC margins in low-reimbursement counties, may exit the CHC market, which narrows participant choice. Third, the rule does not change eligibility or hours, so a CHC participant authorized for 25 hours per week will not see their hours cut because of the rule. The rule pressures the supply side, not the demand side.

What in-home care costs in 2026

Non-medical home care in Pennsylvania is overwhelmingly private-pay or paid by Medicaid waiver, long-term care insurance, or VA benefits. Medicare home health is zero cost to the patient when eligibility tests are met. The two cost pictures could not be more different.

Most PA families cannot sustain pure hourly 24/7 care coverage. The live-in model uses one caregiver who lives in the home, with PA wage-hour rules requiring the caregiver be permitted roughly eight hours of sleep and three hours of meal and rest time per 24-hour period. Live-in is only safe when the consumer can sleep through the night and does not need overnight transfers or toileting.

Medicare home health out-of-pocket cost

For an Original Medicare beneficiary who clears the homebound, skilled-need, physician-orders, and face-to-face-encounter tests and is served by a Medicare-certified HHA, there is no coinsurance, no copay, no deductible, no time limit, and no cap on visits per episode beyond clinical reasonableness. The HHA bills under the federal Home Health Prospective Payment System; the patient owes nothing. Durable medical equipment ordered through the HHA carries the standard 20% Part B coinsurance, which most Medigap plans cover.

How Pennsylvania families pay for in-home care

The funding-source question splits cleanly along the skilled-need line. If a skilled service is needed (RN, PT, OT, speech therapy, medical social work), Medicare-certified home health is the default and zero-cost path. If a skilled service is not needed, the funder depends on income, age, eligibility, and veteran status.

Original Medicare home health

Triggered by the six-test eligibility framework above. Zero patient cost-share. Payment under PDGM in 30-day periods within recurring 60-day certification cycles. LUPA threshold rules can affect agency payment but not patient access.

Medicare Advantage home health

MA plans must cover at least the Medicare home health benefit, but plan-level prior authorization and concurrent review add friction. Some MA plans, particularly D-SNPs, offer expanded supplemental in-home benefits like meal delivery and in-home support hours.

PA Medicaid (Community HealthChoices)

For dual-eligible PA seniors who clear nursing-facility level of care, Community HealthChoices is the dominant LTSS payer. CHC covers Personal Assistance Services (the non-medical aide service) through either the Agency Model or the Participant-Directed Model, plus skilled home health when needed, service coordination, adult day services, home-delivered meals, personal emergency response, environmental modifications, and respite. The authorization process runs through the Functional Eligibility Determination (the NFLOC determination) and the Person-Centered Service Plan developed by the participant's Service Coordinator. PAS hours are expressed in hours per week and scaled to the participant's assessed level of need.

CHC Participant-Directed Model

CHC participants who qualify for PAS can choose to direct their own services. They become the legal employer of record and hire a Personal Care Attendant directly. The state contracts with a Fiscal/Employer Agent (FEA) that handles payroll, taxes, worker's compensation, and benefits. The participant chooses the schedule, trains the aide on tasks, and supervises performance, with Service Coordinator support.

The federal "legally responsible relative" provision at 42 CFR § 441.360(g) prohibits paying spouses of competent adults absent an explicit "extraordinary circumstances" waiver election, which PA has not made for general use. Adult children, siblings, nieces, nephews, in-laws, friends, and neighbors can all be paid as PCAs in the standard PD model. Spouses cannot be. Parents of minor children with disabilities cannot be paid for caring for those children, for the same legally-responsible-relative reason. The PCA hourly rate is set by the CHC managed care organization and varies by region; rates are rising as the HCBS Access Rule pushes wage floors upward through 2030.

OPTIONS

OPTIONS is Pennsylvania's state-funded home and community-based program for adults 60 and over who do not qualify for Medicaid but cannot afford full private-pay home care. It is administered through PA Area Agencies on Aging under the Department of Aging and is funded by the Pennsylvania Lottery and federal Older Americans Act Title III funds. Eligibility uses age (60+), a functional assessment by an AAA care manager, and a sliding-scale cost share that runs from $0 at the lowest income tier to roughly 100% at the upper end. Many counties operate wait lists. Contact the PA Department of Aging to be routed to your local AAA.

LIFE Program

LIFE (Living Independence For the Elderly) is PA's branding for the federal PACE model. Adults 55 and older who clear NFLOC and live in a LIFE service area can voluntarily enroll. LIFE pays the entire cost of all Medicare and Medicaid services through a single capitated provider and covers in-home aide hours, home-delivered meals, skilled nursing visits at home, PT/OT/SLP at home, home modifications, 24-hour on-call support, and transportation to the LIFE day center and to medical appointments. The Interdisciplinary Team decides the in-home services package; there is no separate "PAS budget" the way CHC has. LIFE participants who need 24-hour care typically receive a combination of day-center attendance and at-home aide hours, with the day center substituting for at-home time when participants attend.

VA pathways

For wartime veterans and surviving spouses, the VA's improved-pension program offers Aid and Attendance and Housebound benefits. The 2026 Aid and Attendance maximum monthly benefit runs $2,424 for a single veteran, $2,874 for a veteran with one dependent, and $3,845 for two married veterans both qualifying for A&A. A&A is cash that the veteran can use for any care need, including non-medical home care. Eligibility requires wartime service, an honorable or general discharge, income below the pension MAPR after deducting unreimbursed medical expenses, and net worth under the 2026 limit of $163,699. VA enforces a three-year asset-transfer lookback, distinct from the five-year Medicaid lookback.

The VA also runs a Homemaker / Home Health Aide program through Geriatrics & Extended Care (GEC), which contracts with community HCAs to provide non-medical aide services to enrolled veterans, typically 8 to 28 hours per week. Veteran-Directed Care is the VA's equivalent of the CHC Participant-Directed Model, and unlike CHC PD, VDC permits paying spouses. The Caregiver Support Program runs PCAFC (the higher-tier program with monthly stipends and CHAMPVA-eligible health insurance) and PGCSS (the general-tier program with respite and education but no stipend).

Long-term care insurance

PA does not have a public LTCI program. Stand-alone LTCI policies issued before roughly 2010 typically have generous home care benefits in the $200 to $300 per day range with elimination periods of 30 to 90 days. Newer hybrid life/LTC products pay home care benefits at 2% to 4% of the policy face value per month after the elimination period. Claims typically require a licensed clinician's certification of inability to perform two or more ADLs or severe cognitive impairment, a written plan of care, and a specific provider type. Some policies cover only Medicare-certified providers, which would exclude non-medical home care entirely. PA families holding LTCI policies should read the home care definitions carefully before assuming coverage.

Jimmo v. Sebelius and the maintenance-care misconception

When a PA family is told "Medicare won't cover this anymore" because the patient has stopped improving or has plateaued, the family is being told something the federal courts and CMS rejected more than a decade ago. Jimmo v. Sebelius, settled in 2013, was a class-action lawsuit challenging the so-called "improvement standard." The settlement and the resulting CMS manual revisions confirmed that Medicare coverage of skilled care depends on whether skilled services are required to safely and effectively deliver care, not on the patient's potential for improvement. Maintenance therapy and maintenance nursing are covered when skilled. CMS subsequently revised the Medicare Benefit Policy Manual to remove improvement-standard language and add explicit maintenance-care guidance.

The misconception persists despite Jimmo for a few reasons. PDGM rewards higher-acuity early-period episodes; long-running maintenance episodes can be lower-margin or LUPA-prone, which gives HHAs a financial incentive to discharge plateaued patients. MA plans sometimes deny continued home health based on "no progress" determinations directly contrary to Jimmo, which CMS-0057-F and CMS-4201-F are partially addressing. Provider education is uneven; many home health clinicians, hospital discharge planners, and even physicians have absorbed the improvement-standard belief without realizing it is wrong. And patients and families almost never appeal, so the wrong outcome stands.

When a PA family is told Medicare is ending coverage, the steps are these. Ask for the denial in writing with the specific reason cited. Reference Jimmo explicitly: "I understand under the Jimmo v. Sebelius settlement, Medicare covers maintenance care when skilled services are required." If a Notice of Medicare Non-Coverage (NOMNC) was issued, request an Expedited Determination by the Quality Improvement Organization within the 72-hour window. Pennsylvania's BFCC-QIO is Livanta (Region 3), reachable through livantaqio.com. If the issue is an MA plan denial, the appeals path runs through plan-level reconsideration, the Independent Review Entity (Maximus Federal), the ALJ, the Medicare Appeals Council, and federal court. The Pennsylvania Health Law Project (phlp.org) and APPRISE (1-800-783-7067) provide free counseling on these appeals.

How to choose a home care agency or home health agency

The right questions to ask differ by service type. For a non-medical HCA, the seven foundational questions are about licensure, retention, supervision, screening, consistency, plan of care, and rate. For a Medicare-certified HHA, CMS Care Compare star ratings and PA DOH BHCQA deficiency history matter most.

Picking an HCA

Ask for the Chapter 611 license number and verify it on the PA DOH website. Ask the agency for its 12-month employee retention rate; above 70% is a strong quality signal in 2026 PA, below 50% is a red flag. Ask about supervision frequency. Chapter 611 requires at minimum every 6 months for ongoing clients, but quality agencies do home supervisory visits every 60 to 90 days. Ask for the supervising RN's name and contact information. Ask about background checks: PATCH, FBI fingerprint, OAPSA, child-abuse clearance, and TB testing should all be in place. Ask about caregiver consistency; rotating caregivers is harder on dementia patients and on continuity of care. Ask whether the rate includes backup coverage when your assigned caregiver is sick or quits.

The five red flags are a refusal to provide license number or supervising RN contact, demand for cash payment or unreasonable advance payment, no written service plan, openly high caregiver turnover, and pressure tactics ("sign today or rates go up tomorrow"). PA Homecare Association membership is a quality signal beyond Chapter 611 minimums, as are Joint Commission, CHAP, or ACHC home care accreditation.

Picking an HHA

Start with CMS Care Compare at medicare.gov/care-compare/ and filter by ZIP code. There are two star ratings: a Quality of Patient Care Star Rating (clinical-outcomes-based, OASIS- and claims-derived) and a Patient Survey Star Rating (HHCAHPS-based). Three or more stars on both is the working threshold for a quality candidate; four or more is excellent. Look at the underlying measures: Improvement in Ambulation, Improvement in Bed Transferring, Improvement in Bathing, Discharged to Community, Acute Care Hospitalization (lower is better), ED Use without Hospitalization (lower is better), and Timely Initiation of Care.

Then check PA DOH BHCQA deficiency history. The Bureau conducts on-cycle and complaint-driven HHA surveys; the results, including any Condition-level or Standard-level deficiencies, are public. A pattern of repeat condition-level deficiencies is a serious red flag.

When the hospital discharge planner offers HHA options, the federal patient-choice rule under 42 USC § 1395x(m)(2)(A) means the family can override the planner's preferred agency. Hospitals often have informal relationships with specific HHAs, sometimes through health-system ownership, and the star-rating differences between system-affiliated and independent HHAs are sometimes substantial.

A 60-second framework for choosing home care vs. home health

Four questions get most PA families to the right answer.

First, does the person need a skilled service (RN visit, PT, OT, speech therapy, wound care, medication injection)? If yes, the home health pathway is the right starting point, and the discharging hospital or PCP can refer to a Medicare-certified HHA. If no, the home care pathway is the right starting point.

Second, is the person homebound? A homebound patient with a skilled need is fully covered by Original Medicare or MA HHA. A non-homebound patient with a skilled need can still get the skilled service through outpatient PT/OT or as a privately funded in-home visit, but Medicare home health requires homebound status.

Third, is the person dual-eligible (Medicare and Medicaid)? Dual-eligibles who clear NFLOC use Community HealthChoices for LTSS and can choose Agency or Participant-Directed Model for PAS. Non-Medicaid 60-and-over should explore OPTIONS. Non-Medicaid 55-and-over in a LIFE service area who clear NFLOC should explore LIFE. Veterans should explore VA pathways. LTCI policy holders should explore an LTCI claim. Everyone else is private-pay.

Fourth, does the family want to be paid for caregiving? If the person is CHC-eligible, the Participant-Directed Model lets adult children, siblings, and friends be paid (but not spouses, in most cases). If the person is a veteran, Veteran-Directed Care or PCAFC is the path. If the family is self-funded, a private family arrangement (with no Medicaid pay involved) is unrestricted.

How home care, home health, CHC, OPTIONS, and LIFE compare

Talk to Polaris before you commit

Choosing between home care and home health, or layering Medicare home health on top of CHC PAS, or deciding whether the Participant-Directed Model is right for your family, is rarely a clean decision. Most PA families end up using more than one pathway over the course of a parent's care, and the sequence matters because the eligibility windows for each program (CHC NFLOC, OPTIONS sliding scale, LIFE service area, VA priority groups) all have their own timing.

Polaris is Brevy's free care navigator for Pennsylvania families. Tell Polaris what your parent needs, what funding sources you have access to, and where you live. Polaris will map out which programs to apply to in what order, flag the timing pitfalls (CHC takes weeks to months to authorize PAS hours), and connect you with the right local resources. Start at brevy.com/polaris.

Key 2026 facts

• PA non-medical home care licensing: 28 Pa. Code Chapter 611, administered by PA DOH BHCQA Division of Home Health
• PA Medicare-certified home health licensing: 28 Pa. Code Chapter 601 plus federal 42 CFR Part 484
• Medicare home health out-of-pocket cost: $0 (DME ordered through HHA carries 20% Part B coinsurance)
• CHC Participant-Directed Model PCA pay rate: set by CHC MCO; rising as HCBS Access Rule pushes wage floors upward through 2030
• OPTIONS sliding scale: $0 to roughly 100% participant share depending on income tier
• HCBS Access Rule 80% direct-care compensation deadline: July 9, 2030
• Pennsylvania QIO for home health appeals: Livanta BFCC-QIO Region 3
• PA Department of Aging Senior Helpline: 1-800-753-8827
• PA Independent Enrollment Broker: 1-877-550-4227 (CHC and LIFE enrollment)
• APPRISE (PA SHIP): 1-800-783-7067 (free Medicare counseling)
• Pennsylvania Health Law Project: 1-800-274-3258

Eight common misconceptions

1. "Medicare pays for home care." Wrong. Medicare pays for home health when eligibility tests are met. Non-medical home care is not a Medicare benefit.

2. "Medicare home health is only for 30 days after a hospital stay." Wrong. There is no 30-day limit. Coverage continues as long as homebound status and skilled need persist. The 30-day reference families remember is the PDGM payment period, which is an agency billing unit, not a coverage cap.

3. "Medicare will cut off home health if Mom isn't improving." Wrong, per the Jimmo v. Sebelius settlement. Maintenance care is covered when skilled services are required to deliver it safely and effectively.

4. "The home care aide can give Mom her medications." Wrong, in most cases. Without specific RN delegation under the PA Nurse Practice Act, an HCA aide can only remind or cue medication, not administer it.

5. "My spouse can be paid as my CHC personal care attendant." Wrong, in most cases. The federal "legally responsible relative" rule at 42 CFR § 441.360(g) bars spouse pay in the standard PA CHC PD model. Adult children and other relatives are eligible.

6. "OPTIONS is the same as Medicaid." Wrong. OPTIONS is state-funded under the Department of Aging, has no asset test, uses a sliding scale instead of a flat copay, and serves seniors 60 and over who do not qualify for Medicaid.

7. "I can have CHC and LIFE at the same time." Wrong. They are mutually exclusive. A PA senior eligible for both must choose.

8. "VA pays for everything for veterans." Partially. VA pays substantially for enrolled veterans, but priority-group structure, face-to-face encounter requirements, GEC authorization layers, and capacity constraints are real.

Frequently asked questions

Where to go next

If your parent is being discharged from the hospital, start with the Medicare home health pathway. Ask the discharge planner for two or three Medicare-certified HHA options, look them up on CMS Care Compare, and exercise your federal patient-choice right. The Brevy guides on Pennsylvania nursing homes, Pennsylvania assisted living, and Pennsylvania memory care cover the residential settings that some families ultimately need when home is no longer a safe option.

If your parent needs ongoing non-medical help and may qualify for Medicaid, start the Community HealthChoices application now. The Brevy guide on Community HealthChoices walks through eligibility, enrollment, and how to navigate the three CHC managed care organizations. The Brevy guide on getting paid as a family caregiver in Pennsylvania walks through every path that lets a relative be compensated for the care they are already providing.

If your parent does not qualify for Medicaid but needs more help than the family can afford, call the PA Department of Aging Senior Helpline at 1-800-753-8827 and ask about OPTIONS. If your parent is a wartime veteran, the VA's Aid and Attendance benefit and the Veteran-Directed Care program may be available. The Brevy guide on paying for senior care in Pennsylvania puts the funding sources side by side.

Find personalized guidance on home care and home health in Pennsylvania at brevy.com.