Home health after hospital discharge in Philadelphia is paid by Medicare, while daily personal help comes from Community HealthChoices or OPTIONS; here is how they differ.
By Philly Senior Advisor Care Team — Hospital & Veteran Transitions Team · October 17, 2026
A common Philadelphia scene goes like this. A seventy-nine-year-old widow in a Roxborough rowhouse has a hip repair at Thomas Jefferson University Hospital or a pneumonia stay at Temple University Hospital. On the last afternoon, the discharge planner hands over a packet that lists a home health agency. The family relaxes, assuming that a professional will now arrive every morning to bathe, dress, and feed their mother. Then the first week at home goes by and the agency has sent a physical therapist for an hour, twice, and a nurse for forty minutes. Nobody has helped her into the shower. The daughter is calling the agency, furious, and the agency is telling her, accurately, that this is all the benefit was ever designed to do. Home health after hospital discharge in Philadelphia is one of the most misunderstood handoffs in the whole system, and the confusion costs families weeks of avoidable stress.
The root of the problem is that two entirely different programs share the phrase "care at home." Medicare home health is a short-term, skilled, medically oriented benefit. It exists to get a person recovering from an acute event back on their feet, and it ends when the skilled need ends. Daily personal assistance, meaning the hands-on help with bathing, toileting, meals, and mobility that makes a long-term difference, is a separate long-term-care service in Pennsylvania. It is funded mainly through Community HealthChoices, the state's Medicaid managed long-term-care program, or through the Pennsylvania Department of Aging's OPTIONS Program. Understanding which door leads where, and in what order to knock, is the most useful thing a family can do in the 48 hours before discharge.
Original Medicare covers home health when a physician or an allowed practitioner certifies that the patient is homebound, needs intermittent skilled nursing or therapy such as physical therapy, occupational therapy, or speech-language pathology, and is under a plan of care reviewed regularly. The agency must be Medicare-certified, and in Pennsylvania home health agencies are also licensed by the Pennsylvania Department of Health. There is no copayment for the covered home health services themselves, although durable medical equipment such as a walker or hospital bed carries a coinsurance. A face-to-face encounter with the certifying provider must occur within a defined window around the start of care, which is why a hospital discharge is the easiest moment to qualify: the paperwork is fresh and the inpatient team has just documented the need.
Notice what is missing from that description. Nothing in it says the benefit is open-ended or that it covers a caregiver who simply helps with daily life. Home health aides are covered, but only part-time and only while the person is also receiving a qualifying skilled service. When the physical therapist declares the goals met and discharges the patient from therapy, the aide visits stop with them, even if the patient still cannot safely get in and out of a tub. That timing surprises families more than any other rule. Anyone enrolled in a Medicare Advantage plan should also call the plan before leaving the hospital, because some plans require prior authorization or a contracted agency, and a delay of a few days at the start can leave a frail person without any visit at all.
Community HealthChoices, usually shortened to CHC, is Pennsylvania's mandatory managed-care program for Medicaid long-term services and supports, run through the Department of Human Services' Office of Long-Term Living. Its personal assistance services are the benefit families are really hoping for when they imagine daily help at home: aides who help with bathing, dressing, toileting, meal preparation, and getting around the house. A participant works with a service coordinator employed by the CHC managed-care organization, who builds the plan, and the participant can choose an agency model or direct the aide themselves through the participant-directed option. CHC does not pay room and board if the person later moves to a personal care home or assisted living residence, but at home it can carry the weekly routine for years.
The catch is timing. CHC is a Medicaid program, so it requires both financial eligibility and a functional assessment showing the person needs the level of care a nursing facility provides. Those steps run through the state's independent enrollment broker and county assistance office, and they take weeks, not days. People who are already dually eligible for Medicare and Medicaid are enrolled differently from those who are newly applying, so the speed varies. The practical lesson is to ask the hospital social worker at Hospital of the University of Pennsylvania, Pennsylvania Hospital, Einstein Medical Center Philadelphia, or any other Philadelphia hospital about CHC on the first or second day of the stay, not on the day the bed is needed. Families who start the application during the admission often have a service coordinator assigned by the time Medicare home health visits taper off.
For many Philadelphians the gap between the end of Medicare home health and the start of CHC services is where the real danger sits. The Philadelphia Corporation for Aging, the city's Area Agency on Aging, administers the Pennsylvania Department of Aging's OPTIONS Program locally. OPTIONS is funded by the Pennsylvania Lottery, uses a sliding fee scale, and offers care management plus in-home services such as personal care, home-delivered meals, and adult day services without requiring the Medicaid-level financial spend-down. It is a separate program from CHC and from LIFE, and it is also unrelated to the state's PACE and PACENET prescription-drug subsidy, though people mix the names up constantly. A call to the PCA helpline during the hospital stay can start an assessment, and a care manager can sometimes arrange a stopgap plan while the larger application moves along.
In the collar counties the same function belongs to different offices: Montgomery County Aging and Adult Services, the Bucks County Area Agency on Aging, the Delaware County Office of Services for the Aging, and the Chester County Department of Aging Services. A family in Abington, Media, Doylestown, or West Chester should call that county agency rather than the Philadelphia one. Whichever office applies, give them the planned discharge date, the diagnosis, and the name of the home health agency, so the care manager can time the handoff. If the person has a trusted neighbor, a church member, or a family caregiver who can cover the hands-on tasks for a few weeks, say so; the assessment treats that support honestly, and it is better to plan around it than to pretend it does not exist.
The most productive hospital conversations are specific. Ask which home health agency has accepted the referral and whether it has confirmed a start-of-care date within forty-eight hours. Ask whether the doctor has documented that your parent is homebound, since that word has a particular meaning under Medicare and a vague note can cause a denial. Ask what skilled services are ordered and for how many weeks, and then ask the harder question: what is the plan on the day those visits end? A planner may not volunteer that last answer, but a well-run Philadelphia discharge team will tell you who at the county agency or CHC organization is expected to pick up the thread.
Finally, write down who to call. Home health agencies are surveyed and listed through Medicare Care Compare, and you can check an agency's quality ratings and inspection history before you accept the first name on the list; patients have the right to choose among Medicare-certified agencies that serve their address. If something goes wrong, the Pennsylvania Department of Health takes complaints about licensed home health agencies, and the Pennsylvania Long-Term Care Ombudsman Program, housed within the Department of Aging, helps with problems involving long-term-care services. Veterans have an extra path through the Corporal Michael J. Crescenz VA Medical Center, whose home-based care programs can sometimes be arranged alongside Medicare. Keeping the program names straight, and asking about the next step before the current one ends, is what keeps a recovery from becoming a second hospital stay.
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