How Medicaid Pays for Adult Day Care in Pennsylvania (Community HealthChoices)

In Pennsylvania, Medicaid pays for adult day care through a program called Community HealthChoices (CHC) — the state’s Medicaid managed long-term services and supports program. For families whose loved ones meet the eligibility criteria, CHC can cover adult day care at SarahCare with no out-of-pocket cost. Understanding how this works is the first step toward accessing it. 

What Is Community HealthChoices? 

Community HealthChoices is Pennsylvania’s Medicaid waiver program for older adults and individuals with physical disabilities who need long-term services and supports (LTSS). CHC replaced the older OBRA and attendant care waiver programs and is now the standard pathway for Medicaid-funded community-based care in Pennsylvania. 

CHC is managed through three Managed Care Organizations (MCOs) in the Southeast Zone — which covers Philadelphia, Montgomery, Bucks, Chester, and Delaware counties: 

• Keystone First Community HealthChoices 

• UPMC Community HealthChoices 

• PA Health & Wellness 

SarahCare Adult Day Center in Jenkintown is in-network with all three MCOs. If your loved one is enrolled in any of these plans, SarahCare can begin the coordination process. 

Does My Loved One Qualify for CHC Adult Day Services? 

CHC eligibility has two components: functional eligibility and financial eligibility. 

Functional Eligibility 

To qualify for CHC, an individual must be determined to need a nursing facility level of care — meaning they have significant limitations in activities of daily living (ADLs) such as bathing, dressing, toileting, transferring, and eating. This assessment is conducted by the Pennsylvania Department of Human Services through a standardized tool called the LTSS Needs Assessment. The assessment does not mean the person must move to a nursing facility — it simply establishes that their care needs are significant enough to qualify for waiver services. 

Financial Eligibility 

CHC participants must be financially eligible for Medicaid. Income and asset limits apply. The County Assistance Office (CAO) in your county handles Medicaid financial eligibility determinations. For many families, a Medicaid planning professional or elder law attorney can help navigate this component, particularly around asset limits for married couples. 

What We See in Practice 

The word ‘nursing facility level of care’ throws a lot of families off when they first hear it. They think their parent isn’t sick enough, or that they shouldn’t be applying for something that sounds so clinical. In our experience, many people living at home with real daily care needs — memory issues, mobility limitations, chronic health conditions — do qualify under this standard. The threshold isn’t about severity; it’s about the types of limitations a person has. We encourage families to let the assessment happen and not pre-disqualify themselves based on the name of the standard. 

How CHC Pays for Adult Day Care at SarahCare 

Once a participant is enrolled in CHC and their care plan includes adult day services, the MCO pays SarahCare directly for the participant’s days of attendance. The participant (or their family) generally pays nothing out of pocket for the adult day care services covered under the plan. 

Each CHC participant has a Service Coordinator assigned by their MCO. The Service Coordinator works with the participant and family to build a care plan that reflects their needs and preferences, including which adult day center they’ll attend, how many days per week, and what additional services may be needed. SarahCare’s enrollment team coordinates directly with MCO Service Coordinators to streamline the process. 

Step-by-Step: How to Enroll in CHC and Access Adult Day Care 

1. Contact the Pennsylvania OLTL (Office of Long-Term Living) at 1-800-753-8827 to begin the CHC enrollment and assessment process, or contact your local Area Agency on Aging (AAA). 

1. Complete the LTSS Needs Assessment — conducted by a DHS assessor, typically in the home. This establishes functional eligibility. 

1. Complete the Medicaid financial eligibility application through your County Assistance Office if not already enrolled in Medicaid. 

1. Choose an MCO from the three options in the CHC Southeast Zone: Keystone First, UPMC Community HealthChoices, or PA Health & Wellness. 

1. Work with your MCO Service Coordinator to build a care plan that includes adult day services. Specify that you’d like to attend SarahCare in Jenkintown. 

1. SarahCare coordinates with your MCO to confirm authorization and schedule your start date. We’re familiar with the intake process for all three Southeast Zone MCOs. 

For a more detailed walkthrough of the enrollment steps, see our post: How to Enroll Your Parent in Adult Day Care Through Community HealthChoices. 

Other Medicaid Programs That May Cover Adult Day Care 

In addition to CHC, some participants may access adult day services through the Montgomery County Office of Senior Services OPTIONS program, which provides supplemental funding for community-based care for seniors not yet enrolled in CHC. The Philadelphia Corporation for Aging (PCA) administers similar OPTIONS funding for Philadelphia residents. Contact your local AAA for details. 

Frequently Asked Questions 

Ready to Learn More? 

Schedule a free tour of SarahCare Adult Day Center in Jenkintown. 

Call us: 215-999-1200 or contact us here. 

Written by Sophia Aloia  |  Content & SEO Manager, SarahCare 

Sophia Aloia manages content and community education at SarahCare, with a focus on helping Pennsylvania families understand Medicaid waiver programs and access the long-term care services their loved ones need.