5 Things Philadelphia Families Get Wrong About Medicaid Home Care

Mistake 1: Assuming Your Loved One “Isn’t Sick Enough” to Qualify

Families assume Medicaid home care is only for people who are completely bedridden. The functional assessment looks at whether your loved one needs regular help — not whether they can do literally nothing. Someone who needs help bathing safely, managing medications, or avoiding falls may qualify. The threshold is much lower than most families expect.

Mistake 2: Not Knowing That Family Members Can Be Paid Caregivers

Many families go through the entire process without learning about Participant-Directed Services and the Agency with Choice model. They accept a stranger from an agency when a daughter, son, or sibling could have been hired and paid. It’s not too late to switch — contact your MCO’s service coordinator.

Mistake 3: Waiting Until a Crisis to Apply

The process takes four to eight weeks. Starting during a hospital discharge or emergency means making decisions under pressure. If your loved one is showing signs of declining ability, start the application now.

Mistake 4: Accepting the First MCO Without Asking Questions

You can choose between AmeriHealth Caritas, Keystone First CHC, and PA Health & Wellness. Each has different responsiveness, service coordinators, and approaches to authorizing services. Ask questions before accepting.

Mistake 5: Not Appealing When Services Are Denied or Insufficient

Denials and low-hour authorizations can be appealed through the MCO or a Fair Hearing with the Department of Human Services. Appeals are won more often than families expect.

Have questions? → Talk to CareChoice