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Medicaid / Pennsylvania

Medicaid for Home Care in Pennsylvania

Medicaid Certified Home Care Agency in Pennsylvania

An agency offering homecare services could claim Medicaid in Pennsylvania only if they are certified as an HHA (Home Health Agency). There are some regulations that should be considered as well before claiming Medicaid. Many regulations must be followed by the agencies to be compliance in their state. Apart from this, license and certification are mandatory for agencies. Details are offered by Bureaus of Licensing and Certification.

Governing Body: Pennsylvania Medicaid


In Pennsylvania, Medicaid is also referred as Medical Assistance (MA) and aims to provide coverage to low-income residents including individuals from 19 to 64 years of age, seniors, blind and disabled people, and families with children under the age of 21 years.

Medicaid Programs:

  • Pennsylvania Department of Aging (PDA) Waiver
  • Services My Way
  • Community Health Choices (CHC) Program

Income Requirements:

  • For individuals from ages 19 to 64, income up to 133% of the FPL ($1,337 per month) for a family of one and $1,800 for a family of two
  • For pregnant women and infants, income within 215% of the FPL ($2,161 per month) for a family of one and $4,408 for a family of four
  • For children ages 1 to 5, household income within 157% of the FPL ($3,219 per month) for a family of four

Application Process:

The application process for accessing Medicaid in Pennsylvania is not complex, and anyone can apply for the available Medicaid programs by visiting COMPASS.

Medicaid with CareSmartz360

Home care businesses require advanced solutions to integrate Medicaid into their services, and Caresmartz has been doing that across the states for home care agencies, private-duty care providers, and home care franchisors for several years. CareSmartz360 is a complete software solution to manage a home care business, and it supports all Medicaid payers, allowing businesses to focus on other operations and processes.

  • Effective and comprehensive management of the revenue cycle.
  • Allows agencies to fulfill billing requirements for Medicaid, Medicare, Insurance, and Private Pay.
  • Built-In feature to submit claims electronically.
  • Quickly create, review, approve and submit claims in paper invoice or 837P, 837I format.
  • Helps in generating error-free claims to save time and efforts.
  • Identify and manage accounts and claims that are overdue.
  • Robust reporting to evaluate financial performance.
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    50-State Medicaid Guide

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