Pennsylvania Community HealthChoices: Pennsylvania 2026 Guide

Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for adults who have both Medicare and Medical Assistance, and for adults 21 and older who need a nursing facility level of care. It is run by the Department of Human Services, Office of Long-Term Living, through several managed care organizations.

Here is a plain-language walk-through of Community HealthChoices: who qualifies in 2026, what help it covers, how a family gets started, whether there is a wait, and how it connects to nursing home coverage. For the full statewide rules on income, assets, spouses and the look-back, see our Pennsylvania Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What Community HealthChoices is

CHC covers physical health care and long-term services, including care at home, adult day, assisted living options and nursing facility care. Each member chooses a CHC plan and has a service coordinator. People who need long-term services also go through a functional eligibility determination. LIFE, Pennsylvania’s version of PACE, is an alternative to CHC for people 55 and older in areas where it operates.

Managed long-term services and supports (MLTSS) means the state pays a private health plan a monthly amount to arrange and pay for a member’s long-term care. A care coordinator from the plan writes and updates the care plan, and members can usually pick their plan. Financial eligibility is still decided by the state, and plan decisions can be appealed.

Who qualifies in 2026

Pennsylvania looks at both how much help a person needs and what they own and earn. In general, to qualify for Community HealthChoices an applicant must:

be 21 or older;
be dual eligible for Medicare and Medical Assistance, or need a nursing facility level of care;
for home and community-based services, be found nursing facility clinically eligible, with a functional eligibility determination and a physician certification; and
meet Pennsylvania’s long-term care financial rules.

The money test. Community HealthChoices uses Pennsylvania’s long-term care Medicaid financial rules, which are usually the same income and asset limits used for nursing home Medicaid. Bank and investment accounts count toward the limit, but a home, one vehicle, household goods and limited burial funds generally do not. Gifts made in the five years before applying can trigger a penalty that delays waiver services, just as it would delay nursing home coverage.

In 2026, the special income limit for home and community-based services through CHC is $2,982 a month, and Pennsylvania does not generally offer a Qualified Income Trust route for the waiver group. Nursing home applicants with higher income can qualify as medically needy. The single-person asset limit is $2,000 plus a $6,000 disregard (about $8,000).

For reference, these are Pennsylvania’s key 2026 long-term care Medicaid figures:

Item	2026 figure
Income limit (applicant)	$2,982 a month (special income limit). Nursing home applicants with higher income may qualify as medically needy
Asset limit (single applicant)	$2,000, plus a $6,000 disregard (about $8,000 in total). Medically needy route: $2,400
Asset limit (couple, both applying)	$2,400 per spouse ($4,800 for a couple who both need care)
Home equity limit	$752,000
Spouse at home: resource allowance (CSRA)	Minimum $32,532 / maximum $162,660
Spouse at home: monthly income allowance (MMMNA)	Minimum $2,705 (from July 1, 2026) / maximum $4,066.50
Personal needs allowance (nursing home)	$60 a month
Look-back period	60 months (5 years)

If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services Community HealthChoices can cover

Along with regular Medicaid benefits, Community HealthChoices plans cover these long-term services when the care plan calls for them:

service coordination
personal assistance services, agency or participant-directed
adult daily living services
respite
home-delivered meals
home adaptations and medical equipment
personal emergency response systems
nursing, therapies and home health
nursing facility care
an assisted living option offered by some plans since 2026, in place of other services

Limits to keep in mind. Community HealthChoices does not pay for rent, groceries or utilities; in residential settings, room and board is the resident’s responsibility. Plans of care are built around any unpaid help family already gives, and doctor, hospital and drug coverage continue separately.

How to apply for Community HealthChoices

The steps below describe the usual path. Many people apply for Medicaid and request the waiver at the same time, so that the money and care tests run side by side.

Start the long-term services application through the state’s Independent Enrollment Broker or the state’s online benefits system.
The broker arranges a functional eligibility determination, and a physician certifies nursing facility clinical eligibility.
Submit the Medical Assistance financial application to the County Assistance Office.
Choose a CHC plan with the broker’s help.
The plan’s service coordinator completes an assessment and writes the service plan.

Practical tips. Keep copies of everything you send and note the name of each person you speak with. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Supervision needs, confusion and falls matter as much as hands-on help. A denial notice explains the fair hearing process and its deadline.

Waiting lists and timing

CHC has no waiting list for people who qualify. The process can take several months because of the clinical, functional and financial steps.

Because openings can be limited, it usually makes sense to get on any list early, even before needs are urgent. In the meantime, families often combine state plan personal care, adult day, PACE in areas that have it, and Area Agency on Aging services. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

CHC plans also pay for nursing facility care, so members keep the same plan if they move to a nursing home. Pennsylvania’s medically needy route for nursing home care can help people whose income is above $2,982.

Community HealthChoices usually covers both nursing facility care and care at home through the same plan, so moving between settings does not mean starting over. The same financial rules apply in both settings, but in a nursing facility most of the member’s income is paid toward care.

Tips for families

Network matters: check whether each plan includes the providers you already rely on. Request a copy of the plan of care and read it. If hours are cut or a request is denied, get the decision in writing; appeal deadlines are short. Five years of financial records are usually needed, and the look-back applies as with any long-term care Medicaid.

Many families find it worthwhile to talk with a Certified Medicaid Planner before applying for Community HealthChoices. A planner who knows Pennsylvania’s rules can review income and assets, explain which program fits, map the timing against any waiting list, and help with the paperwork. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.