Become a Medicaid Provider in Pennsylvania

Q: How do I become a Medicaid provider in Pennsylvania?

Apply through Pennsylvania Department of Human Services (DHS). Timeline: 90–150 days.

Pennsylvania Medicaid at a Glance

Program Name

Pennsylvania Medicaid (Medical Assistance)

Managing Agency

Pennsylvania Department of Human Services (DHS)

Reimbursement Rates

$18–$26/hour for personal care; $48–$95/visit for skilled nursing

Application Timeline

90–150 days

Enrollment Process: Step by Step

1
Apply through PROMISe Provider Enrollment
2
Complete DHS Provider Application
3
Submit NPI, EIN, and PA business registration
4
Complete PSP background checks (Act 33/34/73)
5
Obtain PA DOH Home Health Agency License
6
Submit liability insurance documentation
7
Contract with PA Community HealthChoices (CHC) MCOs

Accepted Provider Types

Home Health Agencies Home Care Agencies Personal Care Homes Private Duty Nursing

Required Certifications & Licenses

✓ PA DOH License
✓ NPI Number
✓ Act 33/34/73 Background Checks

Waiver Programs in Pennsylvania

These Medicaid waiver programs fund home and community-based services in Pennsylvania:

Community HealthChoices (CHC)

OBRA Waiver

COMMCARE Waiver

Adult Autism Waiver

Consolidated & P/FDS Waivers

Billing System

PROMISe system + CHC MCO billing (AmeriHealth Caritas, Keystone First, PA Health & Wellness)

⚠️ Common Denial Reasons

✗ Missing DOH license
✗ Act 33/34/73 check incomplete
✗ CHC MCO credentialing delays

💡 Tips for Approval

★ Pennsylvania moved LTSS to managed care via CHC
★ CHC MCO contracts are essential for home care
★ DOH licensure takes 3–6 months
★ PA has strong demand due to aging population

Need Help Enrolling in Pennsylvania?

Our team specializes in Medicaid provider enrollment for home care agencies. We'll guide you through every step.

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Other States

AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR RI SC SD TN TX UT VT VA WA WV WI WY

Frequently Asked Questions — Medicaid in Pennsylvania

How do I become a Medicaid provider in Pennsylvania?

To enroll as a Medicaid home care provider in Pennsylvania, you must apply through Pennsylvania Department of Human Services (DHS). The process includes: Apply through PROMISe Provider Enrollment. Timeline: 90–150 days.

What are the Medicaid reimbursement rates in Pennsylvania?

$18–$26/hour for personal care; $48–$95/visit for skilled nursing

What certifications are required in Pennsylvania?

Required certifications include: PA DOH License, NPI Number, Act 33/34/73 Background Checks.

What waiver programs are available in Pennsylvania?

Community HealthChoices (CHC); OBRA Waiver; COMMCARE Waiver; Adult Autism Waiver; Consolidated & P/FDS Waivers

What are common reasons for Medicaid denial in Pennsylvania?

Missing DOH license; Act 33/34/73 check incomplete; CHC MCO credentialing delays

How to Become a Medicaid Home Care Provider in Pennsylvania