Determine if You Qualify

Type Your Pennsylvania County

First Name

Last Name

Phone Number

Email Address

Date of Birth

Your Health Insurance
PA Health and WellnessUPMCAmeriHealth CaritasKeystone First Community Health ChoicesHave Other Insurance ProviderNeed to Change Insurance Coverage

Are you receiving Home and Community Based Services HCBS (Former Waiver Program)
Yes, I have coverageNo, I do not have coverageI would like to sign up for coverage

Select Any Home and Community Based Services (Former Waiver Program)
Non-Medical TransportationHome-CareAdult Day CareHome Delivered MealsPERS (Personal Emergency Response System)

By checking this box, you acknowledge that if you are not currently receiving Home and Community- Based Services (HCBS), the application review process may take up to three months or longer. You authorize New Age Adult Day Care Services, LLC to assist you in applying.