Community HealthChoices Pennsylvania: Eligibility and Enrollment Guide

If your aging parent needs long-term care services in Pennsylvania — whether at home or in a facility — they'll almost certainly go through Community HealthChoices. CHC is the state's mandatory Medicaid managed care program, and understanding how it works is the difference between months of confusion and a clear path to covered care.

What Community HealthChoices Covers

CHC consolidates three types of services into one managed care framework:

• Physical health services — doctor visits, prescriptions, lab work, hospitalizations
• Long-term services and supports (LTSS) — home and community-based care, personal care attendants, adult day programs, assisted living, and nursing facility care
• Behavioral health services — mental health and substance use treatment

Before CHC, Pennsylvania ran these through separate systems with different applications, different caseworkers, and different authorization processes. CHC puts everything under one managed care organization (MCO), giving families a single point of contact for all care coordination.

Who Qualifies

To enroll in Community HealthChoices, your parent must meet both clinical and financial criteria:

Clinical requirement: Your parent must be certified as Nursing Facility Clinically Eligible (NFCE) — meaning they need the level of care a nursing home provides, even if they'll actually receive services at home. A physician completes Form MA 51 to certify this.

Financial requirement: For 2026, the income threshold is $2,982/month (the Special Income Limit), and countable assets must be at or below $8,000 if income is under $2,982, or $2,400 if income exceeds that threshold. Pennsylvania's unique two-tier asset structure makes this income line one of the most consequential numbers in the enrollment process.

If your parent's income exceeds $2,982/month, they may still qualify through Pennsylvania's medically needy spend-down — the state does not require a Qualified Income Trust.

The Five Managed Care Organizations

As of the most recent procurement cycle, Pennsylvania contracts with five MCOs to deliver CHC services statewide:

1. Aetna Better Health of PA
2. Health Partners Plans
3. PA Health and Wellness
4. UPMC For You
5. AmeriHealth Caritas / Keystone First

Not all five plans are available in every county. Regional availability varies, and the specific provider networks, covered services, and care coordination quality differ between plans. This is one of the most important decisions in the enrollment process — the MCO your parent chooses determines which home care agencies, personal care attendants, and facilities are in-network.

How Enrollment Works

Step 1: Contact the Independent Enrollment Broker. Pennsylvania uses Maximus as its enrollment broker. Maximus handles the clinical intake process and helps your family select an MCO. Call PA Enrollment Services at the statewide line to start.

Step 2: Complete the clinical assessment. Your parent's physician completes Form MA 51. The enrollment broker reviews the clinical documentation to confirm NFCE status.

Step 3: Submit the financial application. File Form PA 600 L through the COMPASS online portal or at your local County Assistance Office. Include 60 months of financial statements to satisfy the lookback period.

Step 4: Choose an MCO. Once approved, the enrollment broker provides choice counseling — a comparison of available plans in your parent's county, including provider directories and covered services. If your parent doesn't choose within the enrollment window, the state auto-assigns a plan.

Step 5: Care coordination begins. The selected MCO assigns a service coordinator who conducts a comprehensive needs assessment and develops a person-centered service plan. This plan determines the type and hours of services your parent will receive.

The Home Care Option

One of CHC's most important features is that enrollment doesn't mean nursing home placement. The program is designed to keep people in the community when possible. Services that can be delivered at home through CHC include:

• Personal care attendants for daily living activities
• Home modifications (ramps, grab bars, bathroom accessibility)
• Adult day programs
• Respite care for family caregivers
• Durable medical equipment
• Skilled nursing visits

For families trying to keep a parent at home, CHC's home and community-based services can be the financial lifeline that makes it possible.

The Power of Attorney Connection

Here's where CHC enrollment intersects directly with legal planning: to submit the Medicaid application on your parent's behalf, manage their financial disclosures, select an MCO, and coordinate care decisions, you need legal authority. If your parent lacks the cognitive capacity to handle these steps, you need either a valid power of attorney or a court-appointed guardianship.

A financial POA with "hot powers" is especially critical if your parent needs to restructure assets to meet Medicaid's financial limits — the agent must be specifically authorized to make gifts, create trusts, or adjust beneficiary designations.

The Pennsylvania Power of Attorney & Guardianship Kit connects the legal authority framework directly to the CHC enrollment process — so your documents are in place before you need to navigate the Medicaid application.

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