How Community HealthChoices Works for Family Caregivers in Allegheny County

You are already doing the caring. Mornings, medications, the shopping, the phone calls from the doctor’s office. Somebody at church or at work has said “you know Medicaid might pay for help with that,” and you have no idea whether it is true, what it would take, or whether it would let you keep doing the caring yourself and be paid for it. This is the guide we wish every family in the South Hills had before their first phone call.

The program is called Community HealthChoices, usually shortened to CHC. What follows is how it actually works in Allegheny County, in the order things happen, with the parts that trip families up marked plainly. Program rules change, so where a detail matters we point you to the office that owns it.

What Community HealthChoices is, and is not

CHC is Pennsylvania’s Medicaid program for long-term services and supports. It is run through managed care plans rather than directly by the state, and it is the route by which Medicaid pays for a caregiver to come to someone’s home instead of paying for a nursing facility. It covers adults aged 21 and over who either need a nursing-facility level of care or are eligible for both Medicare and Medicaid.

Two things it is not. It is not Medicare, which pays for short, doctor-ordered home health care after illness or surgery and generally nothing ongoing. And it is not an application you fill in once and wait for; it is a sequence of separate decisions by separate offices, and the sequence is what this article is about.

As of 2026, three plans deliver CHC across the whole state, including Allegheny County: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices. You choose between them, and you can change later. The state has been re-running its selection of plans after a court ruling in April 2026, so the line-up may change in time; the three current plans continue to operate while that happens.

The two tests, and who decides each

Nobody is enrolled in CHC without passing two tests that are run by two different bodies, and much of the delay families experience comes from not realizing they are separate.

The clinical test. Pennsylvania calls this being “nursing facility clinically eligible.” It is decided using a standard assessment called the Functional Eligibility Determination, done in the person’s home by an independent assessor, together with a certification form completed by the person’s own physician. If the assessor and the physician disagree, the state’s medical director decides. It is repeated at least once a year.

The financial test. This is a Medicaid application, decided by the County Assistance Office. It looks at income and at resources, and it looks back five years at anything that was given away or transferred. That look-back is the reason to be careful about “spending down” on a relative’s advice; if there are meaningful assets, an hour with an elder law attorney is money well spent before anything moves.

How the process runs, step by step

Everything starts with one phone number. The Independent Enrollment Broker, which the state contracts to run intake, is 1-877-550-4227, and its website is PAIEB.com. It is statewide; there is no separate Allegheny County line.

1. Call the enrollment broker. They explain the options, which include home-based care, a nursing facility, and for people 55 and over a program called LIFE. They also explain that you can direct your own care, which matters for family caregivers and is covered below.
2. The home visit. A broker representative visits, helps with the paperwork, and helps you get the physician certification form to the person’s doctor. Chase the doctor’s office yourself; that form is a common place for weeks to disappear.
3. The clinical assessment. The broker refers the person for the Functional Eligibility Determination, which is done in the home. Have the medication list, recent hospital paperwork and an honest account of a bad day ready, not a good one. The assessment is about what the person cannot safely do alone.
4. The financial application. The Medicaid application goes to the County Assistance Office, on paper or online through COMPASS at compass.dhs.pa.gov. Bank statements for the look-back period are what usually holds this up.
5. Choosing a plan. Once both tests are passed, you pick one of the three CHC plans. If you do not choose, one is assigned.
6. The service coordinator. The plan assigns a service coordinator, who visits, writes a person-centered service plan, and decides how many hours of which services are authorized. This is the single most important person in the whole process. They work for the plan, not for any agency, and by rule they cannot be related to the participant or to anyone being paid to provide care.
7. Choosing who provides the care. Only now does the question of an agency, or a family member, arise. The participant chooses. The plan does not choose for them, and the choice can be changed if it is wrong.

How long does all of that take? The state does not publish an end-to-end figure. The Pennsylvania Health Law Project, which advises families on exactly this, says the process should not take more than about ninety days, and that a few months is normal. Start before you are in crisis, because CHC does not pay for care retroactively.

Where family caregivers fit

This is the part most national articles get wrong for Pennsylvania, so it is worth being precise.

Under the CHC waiver, family members can be paid to provide personal assistance and respite. There are four exclusions, and they are absolute: the waiver will not pay a participant’s spouse, their legal guardian, anyone holding their power of attorney, or their representative payee for Social Security. Beyond those four, there is no restriction on which relatives may be paid. An adult daughter, a son, a sibling, a grandchild or a niece all qualify, provided they meet the same standards as any other caregiver.

Those standards are real. A relative has to pass the same criminal background check, complete the same training or competency test, and have the same tuberculosis screening as anyone else who does this work. And if one person, related or not, provides more than 40 hours a week of care, the plan reviews and has to approve the service plan.

There are two ways a relative gets paid, and the difference is who the employer is:

• Through a licensed home care agency. The relative is hired as an employee of the agency, which screens, trains, schedules and pays them, records every visit through the state’s electronic visit verification system, and bills the plan. The family deals with one organization. This is the route Cyanjel offers, and it suits families who want the caring without the payroll.
• Self-direction. The participant, or someone they appoint, becomes the legal employer of the caregiver, and a state-contracted financial management vendor (for CHC that is currently Tempus Unlimited) handles payroll and taxes. Pennsylvania calls the two versions of this “employer authority” and, where a flexible budget is added, “Services My Way.” The person running the household as employer cannot also be the paid worker, which is a trap when one adult child is doing everything.

One correction worth making, because families read it online constantly: “Agency with Choice” is a model used by Pennsylvania’s Office of Developmental Programs for people with intellectual disabilities and autism. It is not a Community HealthChoices option, and asking a CHC service coordinator for it will get you a blank look.

Programs that look like CHC but are not

Three other things come up in the same conversations, and confusing them with CHC costs families time.

The Pennsylvania Caregiver Support Program, run through the Area Agency on Aging, gives a family caregiver a care manager and reimburses certain expenses, up to a monthly cap and a lifetime cap for home modifications. It is reimbursement, not a wage, and it is worth applying for whether or not CHC comes through. The Allegheny County Area Agency on Aging’s SeniorLine is 412-350-5460.

Act 150 is a state-funded attendant care program for people aged 18 to 59 with a physical disability who have been found financially ineligible for Medicaid. It is applied for through the same enrollment broker. It is not a Medicaid waiver, whatever a search result calls it.

And there is no ordinary Medicaid route for ongoing personal care for adults in Pennsylvania outside the waiver; the state plan’s personal care benefit is limited to people under 21. For an adult in Allegheny County who needs help at home, CHC is the door.

What an agency can and cannot do for you

We are asked to “speed up the application” most weeks, and the honest answer is that no agency can. The enrollment broker, the assessor and the County Assistance Office are independent of every provider, deliberately.

What we can do is tell you, before you start, whether a relative would qualify to be paid and what the screening involves; help you understand what a service coordinator will ask; employ, train and schedule the relative once hours are authorized; provide respite cover so the family caregiver can actually take a day off; and handle the visit verification and billing so nothing is denied for paperwork. If your situation is not one we can help with, we will say so and tell you who can.

For the money side more broadly, including private pay, long-term care insurance and veterans’ benefits, read Paying for Home Care in Pennsylvania, and for the step-by-step of being hired to care for your own parent, read Choosing a Relative as a Paid Caregiver in Pennsylvania.