Stay in the house you love.
PENNSYLVANIA INDEPENDENT ENROLLMENT BROKER
Waiver services pay for care in your own kitchen - not a facility. This is the whole enrollment path.
FREE
STATE WIDE
ABOUT AN 8-MINUTE READ
ENROLLMENT STARTS AS A CONVERSATION, NOT A PORTAL.
Most families never finish the application. Not because they don’t quality.
A letter, first
They stall because nobody sits down and says what happens after the first call. The paperwork calls it Home and Community-Based Services. Families call it staying home.
The Independent Enrollment Broker is the statewide office whose only job is to get you from “I think we need help” to “care is approved.” They do not send the aides. They do not pick your agency. They do not charge you.
They sit at your table. They send the doctor form. They chase the county. They keep the 86-day clock from running out.
You don’t have to become a case manager to get care at home.
Helpline Monday–Friday, 8:00 a.m. – 6:00 p.m. EST.1-877-550-4227
You want to age in the house you already paid for.
Bathing, meals, getting out of the chair — the days are getting heavier, and a facility is not the plan.
2-4 weeks
Typical wait from first call to the kitchen visit.
86 days
Doctor form and functional assessment must both be in.
90 days
County decision, counted from when PA IEB starts your file.
Six chapters. One helpline. You stay home.
THE PATHNot Sure Where to Start? We’re Here to Guide You!
THE FIRST HOUR
01- Pick up the phone or get a pen. Thats the whole step.
A referral can come from several sources, including an AAA referral, PA 600L, COMPASS application, PA IEB website referral, or verbal authorization.
You do not download a 40-page packet and hope. You call , or apply online, and you say the sentence : I want waiver services.
Call 1-877-550-4227 or visits www.paieb.com
02- Someone comes to the kitchen. Bring whoever helps you.
INTAKE IS A CONVERSATION, NOT AN EXAM
You will meet with an Enrollment Case Manager (ECM) for your intake.
During the intake, the ECM may:
Ask questions about your needs
Explain available programs
Discuss MCO options when applicable
Review your provider choice
Complete or review your Medicaid application if needed
Collect required forms and information
03- See your Doctor.
A Physician Certification (PC/MA570) is requested as part of determining your clinical eligibility.
Your physician will need to provide information such as:
Your diagnosis
ICD-10 code
Appropriate level of care
Length of care
Physician information
Physician signature and license information
Your doctor plays an important role in this step.
04- Functional Eligibility Assessment (FED)
The PA IEB requests a Functional Eligibility Determination (FED).
An assessment is completed to determine whether your needs meet the required level of care for the program you are applying for.
This helps determine whether you meet the clinical requirements for HCBS.
05- Clinical Eligibility Review
Once the Physician Certification and FED are received, your case is reviewed for clinical eligibility.
If the information is conflicting, additional review may be required. If you are found clinically eligible, the process moves forward to financial eligibility.
06- Financial Eligibility Review
After clinical eligibility is established, your information is sent to the County Assistance Office (CAO) for financial eligibility determination.
The CAO may request additional financial documentation and will issue a decision. The presentation notes that the CAO generally has 30–45 days to make the financial determination.
Important: This is a separate part of the process from the clinical review.
If financial eligibility is approved, your enrollment is finalized.
Your information is forwarded to the appropriate MCO, LIFE provider, or Service Coordination Agency (SCA) depending on the program. An approval letter is also mailed to the applicant.
07- Enrollment Completion
STATEWIDE
This is not a Pittsburgh program or a Philadelphia program. It is every county.
Rural township, row house, farm kitchen — PAIEB is the same door. One number
Contacts
AmeriHealth Caritas Community HealthChoices (Southwest zone)
1-855-235-5115 (TTY: 1-855-235-5112)
www.amerihealthcaritaschc.com
Keystone First Community HealthChoices (Southeast zone)
1-855-332-0729 (TTY: 1-855-235-4976)
www.keystonefirstchc.com
Pennsylvania Health & Wellness Community HealthChoices
1-844-626-6813 (TTY: 1-844-349-8916)
www.PAHealthWellness.com
UPMC Community HealthChoices
1-844-833-0523 (TTY: 711)
www.upmchealthplan.com/chc
PA MEDI
Pennsylvania offers a free health insurance counseling program called PA MEDI. It helps older Pennsylvanians with Medicare. Counselors are specially trained staff and volunteers. They can answer your questions about Medicare. They can give you easy-to-understand information about Medicare, Medicare Supplemental Insurance, Medicaid, and Long-Term Care Insurance. Our PA MEDI counselors can help you:
Understand your Medicare benefits, including what services are covered under Medicare Parts A and B and your Medicare Summary Notice
Understand your Medicare Prescription Drug (Part D) benefit
Make informed choices about Medicare coverage choices, Medigap policies, and Medicare Advantage Plans
Understand Medicare eligibility and enrollment
Understand programs such as the Extra Help and Medicare Savings Plan. You may qualify for these programs that help pay for your Medicare premiums, deductible and co-pays, and your prescription drug needs.
Understand and help you with the Medicare appeal process
Understand benefits under Long Term Care policies
Call the PA MEDI Helpline at 1-800-783-7067. The call and services are free and confidential.
PA Link Program
Aging and Disability Resource Centers (ADRC) are a national collection of centers that assist seniors and adults with disabilities who need help with activities of daily living. The ADRC in Pennsylvania is known as the Link.
Pennsylvania has 52 Links that cover all 67 counties. The Links improve access to long-term care supports. They do this through a network of local partners. The partners want to encourage people to use community-based solutions. They also promote your decision making. Their goal is to improve the quality of services regardless of age, physical or developmental disability, or ability to pay.
You and your family can use the Links to:
Easily connect to local services and supports
Explore choices for making a secure plan for independence
Get help applying to find out if you qualify for help paying
Get help to keep living in your community when you have a disability, illness or accident, or to move from an institution back to the community
It is best to reach your local Link through any of the partners. These include your local Area Agency on Aging (AAA) or your local Center for Independent Living (CIL).
You can also call the PA Link to Aging and Disability Resource Center at 1-800-753-8827. The call is free.