Who Pays for Adult Day Care in Pennsylvania? 6 Paths
1 weekThere are six ways adult day care gets paid for in Pennsylvania: Community HealthChoices (Medicaid), the county OPTIONS program, VA health care, long-term
care insurance, county Aging funds such as Philadelphia Corporation for Aging, and private pay. Most families qualify for one of the first three and have never heard of the other five. Community HealthChoices waiver participants pay no cost-sharing at all.
Here’s how to figure out which one is yours.
Start here: two questions
Before the details, answer these.
Is your loved one a Veteran enrolled in VA health care? If yes, start with the VA. It’s frequently the fastest path and the least paperwork-intensive.
Do they have Medicaid, or would they likely qualify? If yes, Community HealthChoices is almost certainly your path. If no — and this is the part families get
wrong — you are not out of options. Skip to OPTIONS below.
→ For the full picture on enrollment, eligibility, and comparing centers, see our complete
guide to adult day care in the Philadelphia area.
1. Community HealthChoices — the primary payer
Community HealthChoices (CHC) is Pennsylvania’s mandatory Medicaid managed long term services and supports program, administered by the Department of Human Services through the Office of Long-Term Living. Adult day services are a covered benefit.
Who it covers: adults dually eligible for Medicare and Medicaid, and adults 21 and older with physical disabilities who need long-term services and supports. Note the age — CHC is not seniors-only, and adults in their forties and fifties with physical disabilities routinely qualify.
Where: CHC runs in five zones. The Southeast zone covers Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Three managed care organizations serve it — Keystone First Community HealthChoices, PA Health & Wellness, and UPMC Community HealthChoices. You may change MCO at any time.
Two eligibility tests:
- Clinical — a determination that the person is nursing facility clinically eligible (NFCE), meaning they’d otherwise need nursing home level care.
- Financial — Medical Assistance income and asset limits.
What it costs the family: nothing. CHC waiver participants don’t pay cost-sharing for covered services.
How to start: the Independent Enrollment Broker, currently Maximus, at 1-844-824-3655 (TTY 711) or paieb.com. You can also call your county assistance office.
Timeline, honestly: the Medicaid application process can run three months or longer from the start of the application to the determination letter, and missing documentation extends it. Anyone who tells you otherwise is guessing.
2. The OPTIONS program — for families over the Medicaid limits
This is the path most families never hear about, and it’s the answer to the single most common question we get: “We have too much in savings for Medicaid — are we just stuck paying?”
Usually, no.
Pennsylvania’s OPTIONS program, sometimes called Help at Home, serves residents age 60 and older and covers adult day services for older adults with functional
impairments or conditions including Parkinson’s, dementia, and related disorders.
The key fact: there are no income requirements to participate. Depending on income, a participant may be asked to contribute toward the cost on a sliding copayment scale — but there is no cutoff that disqualifies you.
Montgomery County runs its own OPTIONS program through Aging and Adult Services, with care management as a core service. A care manager assesses needs, builds a care plan with the older adult’s input, arranges services, and stays involved.
Two caveats. Medicaid, Medicare, or private insurance must be used first before OPTIONS funds apply. And OPTIONS is funded through county allocations — service availability and hours vary by county and by year.
How to start: your county Area Agency on Aging. Montgomery County residents go through Montgomery County Aging and Adult Services.
3. VA Adult Day Health Care
If your loved one served, start here.
Adult Day Health Care is part of the VHA Standard Medical Benefits Package. All enrolled Veterans are eligible if they meet the clinical need for the service and it’s available in their area.
Cost: a copay may apply based on service-connected disability status and financial information. VA lists adult day health care copays at up to $15 per day. The amount is determined through VA Form 10-10EC, the Application for Extended Care Benefits.
Typical schedule: two to three days a week, with up to five possible depending on need and availability. Transportation assistance may be available.
How to start: the Veteran’s VA social worker or case manager. They complete the extended care application and coordinate the referral. If the care is delivered by a
community organization rather than at a VA facility, the Veteran also needs to meet community care eligibility.
There’s a separate pathway with more specific criteria used for State per-diem programs, requiring that the Veteran be enrolled in VA health care, would otherwise
need nursing home care, and has three or more dependencies in activities of daily living, or significant cognitive impairment, or two ADL dependencies plus two additional risk factors such as being 75 or older, high use of medical services, a clinical depression diagnosis, or living alone.
→ VA Adult Day Health Care in Pennsylvania · Does the VA pay for adult day care?
4. Long-term care insurance
Most long-term care policies written in the last two decades cover adult day services. Older policies sometimes don’t.
Three things to check in the policy:
- Is adult day care named as a covered service? Look under community-based or home and community-based benefits.
- What’s the benefit trigger? Usually a specified number of ADL dependencies or a cognitive impairment finding.
- Does it require a licensed provider? Most do. A Pennsylvania-licensed Older Adult Daily Living Center satisfies this.
Also check the elimination period — the number of days you pay before benefits begin —and whether the daily benefit is paid as reimbursement or as a fixed cash amount.
5. County Aging funds and Philadelphia Corporation for Aging
For Philadelphia County residents, Philadelphia Corporation for Aging administers county-level aging services and can serve as a funding pathway. Montgomery County residents access county funding through Aging and Adult Services and the OPTIONS program described above.
Both operate through an assessment and care management process, and both may involve cost-sharing based on income.
6. Private pay
Nationally, adult day health care runs a median of roughly $95 per day, about $24,700 a year at five days a week, per the CareScout Cost of Care Survey. Pennsylvania averages approximately $2,535 per month in 2026.
Two things worth knowing. First, private-pay rates in this setting track Medicaid reimbursement rates closely, which serve as a benchmark in most markets — so the
pricing spread between centers is narrower than in assisted living. Second, most families who start on private pay while an application is pending later shift to a funded path.
In Pennsylvania, adult day is the least expensive formal long-term care option available. Assisted living averages about $6,480 a month. A semi-private nursing home room averages about $11,954 a month, roughly 25% above the national median.
What we see in practice
Three patterns come up constantly in intake calls.
Families overestimate what disqualifies them. The most common thing we hear is a variation of “we already checked, we don’t qualify.” Usually what happened is that someone checked Medicaid, was told no, and stopped. OPTIONS has no income cutoff. It’s a different program with different rules, and the phone number is different too.
Veterans’ families almost never start with the VA. We regularly meet families who spent months on a Medicaid application before anyone asked whether the person served. If your loved one is an enrolled Veteran, the VA path is frequently faster.
Frequently asked questions
Does Medicare pay for adult day care? No. Medicare doesn’t cover long-term custodial services like adult day. Medicaid through Community HealthChoices does, as do the county OPTIONS program and VA health care.
We’re over the Medicaid asset limit. Are we stuck paying privately? Probably not. The OPTIONS program has no income requirement to participate, though there’s a sliding co-pay based on income. Call your county Area Agency on Aging.
Do CHC participants pay anything for adult day? No. Community HealthChoices waiver participants don’t pay cost-sharing for covered services.
How long does Medicaid approval take? Plan on three months or longer from application to determination letter. Incomplete applications take longer. Start before you’re in crisis.
Can we start while the application is pending? Often yes, on private pay, with a transition once eligibility is determined. Ask the center directly — policies vary.
Which CHC plan should we choose? Keystone First CHC, PA Health & Wellness, and UPMC Community HealthChoices all serve the Southeast zone, and you can switch at any time. The practical question is whether your chosen center and your existing
doctors are in that plan’s network.
Not sure which path is yours? Call 215-999-1200. Our intake team can usually identify your likely funding path in a ten-minute conversation — before you fill out
anything.
Sophia Aloia is Content & SEO Manager for SarahCare of Jenkintown and CareChoice, where she covers Pennsylvania long-term care policy for families.
