An individual who is receiving LTC services must apply for LTC medical assistance in the county where he or she lives. 55Pa. Code § 148.11
When an individual applies for LTC payments before moving into an LTC facility, the application must be made as follows:
In full-service counties (formerly known as OPTIONS counties), the local Area Agency on Aging (AAA) in the county where the individual lives must complete the application for benefits (PA 600L) at the same time it completes the Level of Care Assessment (LOCA). The LOCA is used to decide on functional eligibility for LTC services. The AAA must submit the PA 600L form and the medical evaluation form (MA 51) to the CAO where the LTC facility is located.
NOTE: Allegheny and Philadelphia counties are the only full-service counties.
In all other counties, the individual or the individual’s representative must turn in the PA 600L to the CAO in the county where the LTC facility is located. The AAA must send the medical evaluation form (MA 51) to the CAO where the facility is located.
For HCBS the application must be made as follows:
The individual who will be receiving the services or the individual’s representative must fill out the application for benefits (PA 600L). It must be turned in to the CAO in the county where the individual lives and will receive HCBS.
The HCBS provider must submit the HCBS eligibility/ineligibility/change form (PA 1768) to the CAO.
NOTE: In Community Choice Counties, the HCBS provider must send in an Application for Services in Your Home (PA 600WP) along with the PA 1768. This service in not available statewide. Community Choice Counties are Allegheny, Chester, Cumberland, Dauphin, Delaware, Fayette, Greene, Lancaster, Montgomery, Perry, Philadelphia, and Washington.
If a CAO has an application form or assessment forms for an individual who has entered an LTC facility or will be receiving HCBS in another county, it must forward them to the other county’s CAO. The new CAO must determine eligibility based on the date the PA 600L was received in the former CAO.
The new CAO must determine eligibility for Medical Assistance as well as LTC services. If the individual is eligible, the new CAO must authorize retroactive Medical Assistance to cover medical expenses charged when the individual was in a facility or receiving HCBS in another county. 55Pa. Code § 148.11
Updated March 12, 2012, Replacing October 31, 2008