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.