How to Enroll in PA’s Long-Term Care Programs

Community Health Choices and Long-Term Living Waivers

Step 1 Call

STEP 1:
Call the PA Independent Enrollment Broker (PA IEB) at 1-877-550-4227

  • Inform the enrollment broker that you want to apply for services — they will start by scheduling your first in-home visit.
  • You will be asked to prepare a list of papers for the visit — be sure to read the provided list.
  • PA IEB will send your family doctor a Physician Certification Form to fill out and send back.

Step 2 First in-home visit

STEP 2:
First in-home visit

  • At the visit, a representative from PA IEB will talk with you about your needs and abilities.
  • You will complete your Medicaid application and other required forms.
  • Once your MA application is submitted, your local County Assistance Office (CAO) will review it and may follow up with a letter if additional forms or information is needed.

Step 3 Second in-home visit

STEP 2:
First in-home visit

  • After the first visit, the IEB will contact your local Area Agency on Aging (AAA) and have them schedule an in-home assessment of need with you – the assessment is called Functional Eligibility Determination (FED).
  • The results of your assessment will then be sent to PA IEB for review.

Step 4 Review of your Physician's Certification and Functional Assessment of Need

STEP 4:
A review of your Physician’s Certification and Functional Assessment of Need takes place

  • PA IEB needs to receive your Function Eligibility Determination (FED), as well as the Physician Certification Form within 86 days of the first in-home visit.
  • If both forms are received and you meet the clinical program eligibility, your application is sent to the CAO.

Step 5 The CAO reviews your waiver application

STEP 5:
The CAO reviews your waiver application

    • The CAO will determine if you financially qualify for waiver services. If anything is still missing from your application, they will send you a letter stating how to submit needed information.
    • Once your application is complete, the CAO will either approve or deny it.
    • The CAO will send a notice to you, to PA IEB, and to your selected Managed Care Organization / Service Coordination Agency.
    • The decision on whether you qualify is supposed to be sent out 90 days from the day PA IEB starts your application.
    • If you do not get a decision within 90 days, you can ask for a fair hearing.
    • If your application is approved, then you are enrolled in Home & Community Based Services. If your application is denied, you can ask for an appeal hearing.

 

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I have been receiving services for 17 years and working a full-time position for 17 years also. I would not have been able to work a full-time position without services.
– Jaime