6 Easy Steps
01
Contact the PA Independent Enrollment Broker (IEB)
02
Complete the Medicaid Financial Eligibility Application
03
Complete the Physician Certification Form (MA 570)
04
Functional Eligibility Assessment
05
Choose a Managed Care Organization (MCO)
06
Select a Home Care Provider
You can contact IEB by:
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Phone: 1‑877‑550‑4227
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Website: https://paieb.com (general info)
IEB will:
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Start the application
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Explain required documents
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Mail or email forms
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Schedule assessments
IEB will help the applicant:
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Apply for Medicaid (if not already enrolled)
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Submit income and asset documentation
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Provide ID, Social Security number, and residency proof
This step determines financial eligibility
This form must be:
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Completed by an MD or DO only
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Returned to the IEB within 5 business days
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Fully filled out, including diagnoses and level of care
The form determines clinical eligibility, including:
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NFCE (Nursing Facility Clinically Eligible)
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NFI (Nursing Facility Ineligible)
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ICF/ORC (Intermediate Care Facility for Other Related Conditions)
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IEB will schedule an in‑home or virtual assessment to evaluate:
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Activities of Daily Living (ADLs)
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Mobility
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Cognitive needs
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Safety risks
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Level of care required
This assessment determines whether the applicant meets nursing facility level of care, as described in the Physician Certification Form
Once approved, the applicant must choose one of the three CHC MCOs:
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Keystone First CHC
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UPMC Community HealthChoices
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PA Health & Wellness
The MCO will assign a Service Coordinator and begin the service planning process.
After MCO enrollment, the participant chooses a PAS provider (like Family First Homecare).
The provider must be:
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Credentialed with the participant’s MCO
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Serving the participant’s county
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Able to staff the cas
