For the First Time, Medicaid Can Help Pay for Assisted Living in Pennsylvania
Medicaid-Funded Assisted Living in Pennsylvania
In March, the Office of Long-Term Living (OLTL) provided an update on the Assisted Living Residence (ALR) In Lieu of Service option, now offered through all three Community HealthChoices (CHC) plans. This article explains what participants and advocates should know about assisted living for people enrolled in CHC.
What is the ALR In Lieu of Service Option?
Assisted living residences (ALRs) provide housing, meals, and daily assistance to people who need support with activities of daily living and/or memory care. Services are provided in multi-unit residential settings where residents have private, lockable units with a kitchenette and bathroom.
Under the CHC ALR In Lieu of Service option, Medicaid helps pay for the cost of assisted living for the first time in Pennsylvania. The program is called an "in lieu of service" because assisted living is being provided instead of nursing facility care.
Who's Eligible?
To access CHC assisted living, a person must:
- Be enrolled in a CHC plan and eligible for or receiving CHC Waiver or nursing facility services. It is not possible to apply for CHC assisted living without first enrolling in another CHC program;
- Be assessed by the CHC plan as an appropriate candidate for assisted living; and
- Be accepted for admission by the ALR.
CHC plans may proactively identify members they believe would benefit from assisted living, or members can request consideration on their own. A CHC participant cannot be forced to move to assisted living or threatened with reduced services or other consequences for declining it. If a CHC plan denies an ALR request, the person should be able to appeal that decision.
Background on Assisted Living in Pennsylvania
Licensed ALRs have been available in Pennsylvania since 2011. However, few people with Medicaid-qualifying incomes could afford to live in an ALR, and Medicaid was not available to offset those costs.
In 2024, the Department of Human Services (DHS) began accepting proposals from CHC plans to use Medicaid funding to cover assisted living for members receiving or at risk of needing nursing facility services.
In 2025, 15 CHC participants transitioned to Medicaid-funded assisted living: 7 from a nursing facility and 8 from CHC waiver services. As of January 2026, all three CHC plans offer assisted living as an option.
Availability of CHC Assisted Living
Currently, 18 of the 64 ALRs in Pennsylvania are contracted with at least one CHC plan. The current list of contracted ALRs is available here.
Geographic availability varies significantly. Most participating ALRs are in the western or central parts of the state. Southeastern Pennsylvania has just two ALRs contracted with a CHC plan, despite having 22 ALRs in the five-county region and being home to more than half of CHC participants receiving waiver or nursing facility services.
Additional ALRs are expected to join the program in the future. However, not all facilities commonly thought of as "assisted living" are eligible. Only facilities with a specific Assisted Living Residence license qualify. These are distinct from personal care homes, which hold a different license type and, at 993 facilities statewide, far outnumber ALRs. While personal care homes may offer similar services and amenities, they are not part of the CHC ALR program.
How are ALRs Paid?
If a person is found eligible, the cost of CHC assisted living is shared between the participant and the CHC plan:
- The participant covers room and board and contributes toward the cost of services. As with nursing facility care, most of the participant's income goes to the ALR; the resident keeps only a small monthly personal needs allowance.
- The CHC plan also pays toward ALR services.
What Services Are Provided?
Services provided by the ALR include: a private room and bathroom, all meals, laundry, transportation, housekeeping, assistance with daily living activities (bathing, dressing, etc.), medication assistance, recreational activities, socialization, and other services. The CHC plan continues to cover all other Medicaid services (e.g., doctor visits).
Note: CHC recipients whose assisted living is paid for by the CHC plan are not eligible to simultaneously receive waiver services.
Private-Pay Option: CHC recipients may choose to live in an ALR without using the formal CHC assisted living program. In that case, the resident pays the ALR privately, with no Medicaid contribution. One advantage of this approach, if affordable, is that the individual may separately qualify for the CHC waiver and use waiver services to supplement their assisted living care.
Outstanding Questions
Many questions about the program's practical implementation remain unanswered, including: the standards CHC plans use to determine eligibility for assisted living; whether the room and board requirement means some people will have too little income to qualify; and how many participants each plan anticipates serving through the ALR model.
For More Info
Participants with questions about accessing assisted living through CHC may contact their CHC plan directly. Those not yet enrolled in CHC should contact the Pennsylvania independent enrollment broker (IEB) by completing the online contact form at https://paieb.com/en/online-contact-form or calling toll-free 1-877-550-4227.
