Help Before Medicaid: The Pennsylvania Program Philadelphia Families Skip Because They Assume They Won't Qualify

By Philly Senior Advisor Care Team — Benefits & Costs Team · August 4, 2026

The gap almost every Greater Philadelphia family falls into first

The call we get most often from Roxborough, Bensalem, Norristown, and Media sounds roughly the same every time: a parent is still living at home, still managing most of the day, but the shower has become frightening, the pill organizer is not getting filled, and an adult child is driving over four nights a week to cover the gap. The family has already looked at Medicaid, decided their mother has too much in savings to qualify, and concluded there is no help available until the money runs out. That conclusion is where the PA OPTIONS Program vs. Community HealthChoices question actually matters, because Pennsylvania runs two entirely separate systems for this problem and most families only ever hear about one of them. Community HealthChoices is the Medicaid program. OPTIONS is not - it is administered by the Pennsylvania Department of Aging through the county Area Agencies on Aging, funded largely by the state Lottery, and it operates on a sliding fee scale rather than a Medicaid-style spend-down. A parent with modest savings who is plainly ineligible for Medicaid today can often still get a care manager, a home assessment, and some paid in-home hours through OPTIONS.

Understanding which system you are in changes who you call, what documents you gather, and how long you wait. It also changes what you should be doing with the family's money in the meantime, because the two programs treat assets very differently. Families who assume Medicaid is the only door often spend eighteen months paying $28 to $36 an hour privately for in-home care, exhaust the savings that would have funded a better long-term placement, and only then discover that a sliding-scale program existed the whole time. This piece separates the three Pennsylvania programs that get confused with each other, explains what each will and will not pay for, and gives you the specific county office to call depending on whether your parent lives in Philadelphia, Montgomery, Bucks, Delaware, or Chester County.

OPTIONS: care management and in-home hours without a spend-down

The Pennsylvania Department of Aging's OPTIONS Program is the state's non-Medicaid answer to the exact situation described above. It is delivered locally by the Area Agency on Aging that covers your parent's county, and the entry point is an assessment: an AAA care manager visits, evaluates what your parent can and cannot do independently, and builds a service plan. What that plan can include varies with local funding but commonly covers personal care hours at home, homemaker and chore services, home-delivered meals, personal emergency response systems, adult day services, and - the part families undervalue most - ongoing care management by someone whose job is to keep the plan working. Because OPTIONS is Lottery-funded rather than Medicaid-funded, there is no asset spend-down and no five-year lookback attached to it. Cost-sharing is set on a sliding scale tied to income, so a family with a middle-income parent may pay a partial share rather than nothing, but that share is generally far below the private-pay hourly market.

The two honest limits are capacity and setting. OPTIONS is not an entitlement in the way Medicaid is, which means county waiting lists are real and service hours are finite - this is a program that supplements a family's own caregiving rather than replacing it. And OPTIONS is built around keeping someone at home; it is not a program that pays for a Personal Care Home or Assisted Living Residence placement. If your parent is already past the point where a few weekly hours make the difference, OPTIONS is the wrong tool, and the conversation should move to Community HealthChoices or private pay. Start the assessment earlier than feels necessary. The families who get the most out of OPTIONS are the ones who called their AAA while the situation was still merely worrying.

Community HealthChoices: what Medicaid covers, and the room-and-board blind spot

Community HealthChoices (CHC) is Pennsylvania's mandatory managed-care Medicaid program for long-term services and supports. It is administered through the Department of Human Services' Office of Long-Term Living and delivered by CHC managed-care organizations, which means an enrolled participant picks a plan and works with that plan's service coordinator. CHC has two eligibility tests that both have to be met: a financial test under Medicaid rules, and a clinical test establishing that the person needs a nursing-facility level of care. Once someone qualifies, CHC can cover personal assistance services at home, home modifications, adult day services, nursing facility care, and personal care services delivered inside a licensed Personal Care Home or Assisted Living Residence. That last item is the one families most need explained slowly, because it is only half the bill.

CHC does not pay room and board in a Personal Care Home or Assisted Living Residence. It pays for the care services delivered there. The rent, the meals, and the housing portion of a $4,800 to $6,900 monthly assisted living invoice remain the resident's responsibility, typically covered by Social Security, a pension, and the state's supplemental payment where applicable. This is the single most expensive misunderstanding in Pennsylvania senior care, and it derails placements every month across the five counties. Nursing facility care works differently - CHC does cover long-term nursing facility stays for qualified participants, applying the resident's income toward the cost - which is part of why some families end up in a $11,000-to-$14,000-a-month setting that Medicaid pays for rather than a $6,000 setting it only partly pays for. Ask any community you tour, in writing, whether it accepts CHC and how it handles the room-and-board balance.

The naming trap: LIFE is not PACE, and PACE is not what you think

Pennsylvania has a third program that belongs in this conversation and a fourth name that does not, and the overlap costs families weeks. The third program is LIFE - Living Independence for the Elderly - which is Pennsylvania's brand of the national PACE model of all-inclusive care. A LIFE program such as LIFE Philadelphia takes over as a participant's entire care system: primary medical care, specialists, therapy, prescriptions, transportation, and a day center, all coordinated by one interdisciplinary team, for people who are nursing-facility-eligible but want to stay living in the community. For the right person - medically complex, still at home, with a family able to cover overnight hours - LIFE is often a better outcome than either OPTIONS or a facility placement, and it can be paid through Medicaid, Medicare, or privately.

Now the trap. Pennsylvania also runs its own program called PACE, along with PACENET, and it has nothing whatsoever to do with long-term care. PA's PACE/PACENET is a prescription-drug cost subsidy for older Pennsylvanians - useful, worth applying for, and completely irrelevant to placement or in-home care. Because the national all-inclusive-care model is also called PACE, families routinely call about "the PACE program," get routed to the pharmacy benefit, and conclude that the care program they read about does not exist here. When you are asking about all-inclusive community care in Pennsylvania, use the word LIFE. When you are asking about drug costs, say PACE or PACENET. Being precise on that one word saves a genuinely absurd amount of time.

Who to call first, county by county

Every one of these programs starts at the same place: your parent's county Area Agency on Aging. In Philadelphia - a consolidated city-county, so there is no separate county office to also call - that is the Philadelphia Corporation for Aging (PCA). In the collar counties it is Montgomery County Aging and Adult Services, the Bucks County Area Agency on Aging, the Delaware County Office of Services for the Aging (COSA), and the Chester County Department of Aging Services. Call the AAA for the county where your parent actually lives, not where you live, and ask for an OPTIONS assessment by name. The intake worker can screen for OPTIONS, refer you toward Community HealthChoices if the situation warrants it, and tell you whether a LIFE program serves that address. Ask what the current wait is for an assessment and put a callback date in your calendar.

Two things are worth doing the same week. First, if your parent is a veteran, look separately at VA Aid & Attendance, which can add a monthly benefit on top of a VA pension and stacks with none of the confusion above; the Corporal Michael J. Crescenz VA Medical Center in University City and the VA Caregiver Support Line at 1-855-260-3274 are the places to start. Second, if any part of this is being triggered by a hospital stay at Penn, Jefferson, Temple, Einstein, Abington, Lankenau, Bryn Mawr, or Doylestown, get the discharge planner on the phone before discharge day and ask which of these programs they are already coordinating with. If you ever have a concern about the treatment of an older adult receiving services, the Pennsylvania State Long-Term Care Ombudsman Program sits within the Department of Aging, and the statewide elder-abuse reporting line is 1-800-490-8505 - confirm the current number before you call.

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