Community HealthChoices (CHC) in Pennsylvania: 2026 Plan Guide

Community HealthChoices Pennsylvania, known as CHC, is the Commonwealth's mandatory managed long-term services and supports program. Hundreds of thousands of adult Pennsylvanians age 21 and older receive their Medicaid long-term care, their dual-eligible Medicaid wraparound, or their nursing-facility coverage through one of three statewide CHC managed care organizations: AmeriHealth Caritas Pennsylvania (branded as Keystone First Community HealthChoices in the five-county Philadelphia region), PA Health & Wellness (a Centene subsidiary), and UPMC Community HealthChoices. Enrollment is required for adults 21 and older who are dually eligible for Medicare and Medicaid, who reside in a Medicaid-paid nursing facility, or who receive home and community-based services formerly delivered through the Aging, Attendant Care, Independence, CommCare, or OBRA waivers. Behavioral health is carved out and runs through a separate county-administered BH-MCO, the LIFE program is the voluntary alternative for nursing-facility-eligible seniors age 55 and older, and the intellectual-disability and autism waivers operate under the Office of Developmental Programs rather than under CHC. The program rolled out across 67 counties in three phases between January 2018 and January 2020 and has been statewide ever since.

This guide explains what CHC is, who must enroll, who is carved out, how the three plans differ, how the Services My Way participant-direction option works (including who can be paid as a family caregiver and who cannot), how to enroll through the Pennsylvania Independent Enrollment Broker, what continuity-of-care protections apply when a participant moves between plans, and what to do when an MCO denies or reduces a service.

CHC Versus HealthChoices: The Naming Problem

Before anything else, disambiguate. Pennsylvania has two Medicaid managed-care programs that share an almost-identical name and that confuse families, hospital discharge planners, and out-of-state writers on a daily basis.

HealthChoices (no leading word) is the regular physical-health Medicaid managed-care program. It started in 1997 and serves the non-long-term-care Medicaid population: most working-age adults, parents and children, and pregnant women on Medicaid. HealthChoices physical-health enrollees pick from a roster of MCOs that varies by county.

Community HealthChoices is the long-term-services-and-supports program that this guide is about. It launched in three phases between 2018 and 2020 and serves adults 21 and older who are dually eligible, in a Medicaid-paid nursing facility, or receiving home and community-based services. Three statewide MCOs.

Both programs are administered by PA DHS. Both are mandatory for their respective populations. Both have multiple competing MCOs. They are not the same program. When a hospital social worker says "you'll need to pick a HealthChoices plan," ask whether they mean physical-health HealthChoices or Community HealthChoices, because the answer determines which phone number to call.

Behavioral health is yet a third program family: HealthChoices Behavioral Health, administered through county-based behavioral health managed-care organizations (BH-MCOs). A CHC enrollee almost always has two managed-care plans at once, the CHC-MCO for physical health and LTSS, and the BH-MCO for mental health and substance-use treatment. More on that in the carve-outs section below.

The Three-Phase Rollout

CHC was implemented in three phases over 25 months. Each phase folded an existing population off legacy fee-for-service Medicaid and the predecessor 1915(c) waivers into the new managed-care chassis. The phasing reflected the operational realities of standing up a statewide MLTSS program in a state with 67 counties and several distinct regional healthcare markets.

By the Phase 3 cutover on January 1, 2020, the program covered all 67 counties. The legacy 1915(c) Aging, Attendant Care, Independence, and CommCare waivers all closed to new enrollment by December 31, 2019, and their existing participants rolled into CHC's NFCE-HCBS track. The OBRA Waiver, which serves adults age 18 to 59 who require an ICF/ORC level of care rather than a nursing-facility level of care, remained outside CHC and continues to operate as a standalone OLTL waiver, most recently renewed effective July 1, 2026.

The Three CHC Tracks

CHC categorizes every enrollee into one of three operational tracks. The track determines what services the participant receives, what capitation rate the MCO is paid, and what assessment cadence applies.

Track 1: Nursing Facility Ineligible (NFI). Adults 21 and older who are dually eligible for Medicare and Medicaid but do not meet nursing-facility level-of-care criteria. NFI participants get their Medicaid acute-care wraparound (PCP, specialists, hospital, durable medical equipment, non-emergency medical transportation) through their CHC-MCO, but they do not receive HCBS waiver services. NFI is the largest track by membership because most dually eligible adults do not need long-term-care services. No FED is required for NFI; the categorical pathway is the dual-eligibility status itself.

Track 2: Nursing Facility Clinically Eligible, Home and Community-Based Services (NFCE-HCBS). Adults 21 and older who clear nursing-facility level-of-care and are receiving Medicaid LTSS in the community: personal assistance services, home health, adult day, home-delivered meals, environmental modifications, personal emergency response systems, respite, and structured day program. This is the track that absorbed the legacy waiver populations. Service Coordinators are assigned to every NFCE-HCBS participant, and a written Person-Centered Service Plan is developed.

Track 3: Nursing Facility Clinically Eligible, Nursing Facility (NFCE-NF). Adults 21 and older residing in a Medicaid-paid nursing facility. The CHC-MCO pays the nursing facility per-diem rate, coordinates with Medicare for crossover claims, and handles the patient-pay calculation that determines how much of the resident's monthly income is contributed toward facility cost.

Most CHC members are in the NFI track because most dually eligible adults do not need long-term-care services; a smaller share are in the NFCE-HCBS and NFCE-NF tracks. Most family-caregiver decisions and most of the MCO supplemental-benefit comparisons concentrate in the NFCE-HCBS track because that is where home and community-based services live.

Who Is Carved Out

The carve-outs are the most-misreported axis of CHC. Each carve-out has its own statutory and regulatory anchor, and getting the boundary wrong sends families to the wrong enrollment broker, the wrong phone number, and sometimes the wrong program entirely.

Intellectual-disability and autism waivers (Office of Developmental Programs). The Consolidated, Person/Family Directed Support, and Community Living waivers, plus the Adult Autism Waiver, run separately under PA's Office of Developmental Programs. A person with an intellectual disability or an autism diagnosis who is dually eligible receives their LTSS through an ODP waiver and their physical-health Medicaid through HealthChoices physical-health managed care or fee-for-service Medicaid, not through CHC. The three core ODP waivers all received January 2026 amendments related to Performance-Based Contracting changes.

LIFE program. LIFE, which stands for Living Independence For the Elderly, is Pennsylvania's branding for the federal PACE (Programs of All-Inclusive Care for the Elderly) program. LIFE is voluntary, opt-in, and requires age 55 and older, nursing-facility level of care, residence in a LIFE provider's service area, and the ability to be served safely in the community. LIFE participants are excluded from CHC. A senior eligible for both LIFE and CHC chooses one or the other. A CHC participant can switch to LIFE at any time, and a LIFE participant can switch to CHC at any time.

ACT 150 Attendant Care. Act 150 is a state-only-funded (non-Medicaid) program for Pennsylvania residents age 18 to 59 with permanent physical disabilities who need attendant care but do not qualify for Medicaid. Act 150 charges a sliding-scale copay. Because Act 150 is not Medicaid, its participants are not in CHC. Note that Act 150 is distinct from the legacy Attendant Care Waiver that folded into CHC in 2020; same name family, different programs.

Behavioral health. Mental-health and substance-use treatment are carved out of CHC and delivered through a county-based BH-MCO under HealthChoices Behavioral Health. Each county (or multi-county HHS coalition) contracts with one BH-MCO. The BH-MCO assignment for a CHC enrollee is determined by county of residence, not by member choice. As a result, every CHC member functionally has two MCOs at once: the CHC-MCO for physical health and LTSS, and the BH-MCO for behavioral health. Major BH-MCOs include Community Care Behavioral Health Organization, Community Behavioral Health (Philadelphia only), PerformCare, Magellan Behavioral Health of PA, and Carelon Behavioral Health.

State psychiatric facilities, ICF/ID residents, and adults under 21. All three categories are carved out by statute or by program design.

The most consequential operational implication of the carve-outs is the bifurcated CHC-MCO and BH-MCO structure. A CHC enrollee who needs psychiatric medication management, substance-use treatment, or crisis intervention uses their BH-MCO ID card and BH-MCO network, not their CHC-MCO. The CHC Agreement requires the CHC-MCO Service Coordinator to coordinate with the BH-MCO care manager for participants whose physical and behavioral conditions interact, but the bills, the prior authorizations, and the provider networks remain separate.

The Three Community HealthChoices Pennsylvania Plans

All three CHC-MCOs operate statewide in 2026. The differences among them lie in supplemental-benefit menus, provider-network depth in particular regions, Service Coordinator practice patterns, and parent-organization continuity.

AmeriHealth Caritas Pennsylvania CHC operates statewide as AC PA CHC and rebrands as Keystone First Community HealthChoices in the five-county Philadelphia region (Bucks, Chester, Delaware, Montgomery, Philadelphia). The dual brand reflects the long-running Independence Blue Cross / AmeriHealth Caritas partnership that has dominated Philadelphia Medicaid managed care since the 1990s. Supplemental benefits typically include vision allowance, dental cleanings and exams at no copay, an over-the-counter benefits card, multilingual member services, and partner-provider relationships for HCBS delivery in the Philadelphia region.

PA Health & Wellness is the Pennsylvania subsidiary of Centene Corporation, the nation's largest Medicaid managed-care company by enrollment. Centene brings standardized clinical-operations infrastructure to PA. Notable supplemental benefits in 2026 include at-home physical, occupational, and speech therapy; post-acute support following hospital stays; transportation; cell phones for medical communication; and 90-day prescription refills.

UPMC Community HealthChoices is offered by UPMC Health Plan, the insurance arm of the UPMC integrated delivery system. UPMC's strength is the western-PA tertiary network, and its weakness is comparatively shallower non-UPMC primary-care networks in eastern PA. Supplemental benefits in 2026 include two no-copay oral cleanings and exams per year plus a yearly dental allowance for additional procedures, vision allowance for new glasses or contacts every 12 months, SilverSneakers gym membership, one free personal-training session per year, and additional home-safety products keyed to the Person-Centered Service Plan.

The 2024 reprocurement under RFA 31-22 selected two additional plans (Aetna Better Health Pennsylvania and Vista Health Plan, the latter operated by Health Partners Plans), but readiness reviews and procurement protests delayed full activation past the original January 1, 2025 launch target. As of mid-2026, the three incumbents continue to serve essentially all CHC members. Treat the new entrants conservatively when comparing options: the operational reality on the ground is three plans, not five.

The LTSS service package is the same across all three plans. The CHC Agreement defines the floor of services the MCO must cover, and that floor is identical across all three. Differences show up in supplemental benefits, provider networks, and Service Coordinator practice rather than in the core LTSS array.

The CHC Service Package

CHC plans cover the full Medicaid acute-care service set plus the CHC waiver HCBS array (for NFCE-HCBS members) plus nursing-facility services (for NFCE-NF members).

Acute physical-health services across all three tracks include primary care, specialist physician visits, hospital inpatient and outpatient care, the emergency department, the Medicaid pharmacy benefit (with Medicare Part D primary for duals), durable medical equipment, laboratory and diagnostic imaging, physical and occupational and speech therapy, hospice, short-stay skilled-nursing-facility rehabilitation, and non-emergency medical transportation.

Long-term services and supports for the NFCE-HCBS and NFCE-NF tracks include nursing-facility care (long-stay institutional), Personal Assistance Services (agency-directed or participant-directed), home health, adult day services, home-delivered meals, personal emergency response systems, environmental modifications, respite care, structured day program, specialized medical equipment and supplies, behavioral therapies (limited, coordinated with the BH-MCO), supported employment for working-age participants, telecare, vehicle modifications, Service Coordination, participant-directed goods and services under the Services My Way budget authority, and Financial Management Services through Tempus Unlimited.

Service authorization is governed by 42 CFR § 438.210 as tightened by the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Standard and expedited service-authorization decision windows apply, with shorter clocks for pharmacy prior authorization; verify the current timeframes in the CHC Agreement and the CMS-0057-F Final Rule. If the CHC-MCO fails to act within the required timeframe, the request is deemed approved under the federal deemed-approval rule.

Services My Way and Paid Family Caregivers

Services My Way is the participant-directed Personal Assistance Services option within CHC. It allows NFCE-HCBS participants to hire, train, schedule, and supervise their own Direct Care Workers rather than receive PAS through an agency. For families weighing whether a son, daughter, or other relative can be paid for the caregiving they are already providing, this is the central question.

The two participant-direction models. Under the Employer Authority Model, the participant is the common-law employer of the Direct Care Worker. Hiring, training, scheduling, and supervision sit with the participant; payroll, tax filings, background checks, and workers' compensation are handled by the Financial Management Services entity. Under the Budget Authority Model, the participant has an annual or quarterly budget and can spend it across a wider range of supports. In Pennsylvania practice the Employer Authority Model is the dominant structure for Services My Way.

Who can be the paid Direct Care Worker. Pennsylvania enforces the federal legally-responsible-relative bar without exception. A spouse cannot be paid as a Direct Care Worker for the participant. A parent cannot be paid for a minor child (a moot point in CHC because the program is 21 and older). A parent can be paid for an adult disabled child age 21 or older, because the parent is no longer legally responsible for the adult child's support. Adult children caring for parents, siblings, in-laws, grandchildren, cousins, and friends can all be paid as Direct Care Workers with no relationship restriction.

Tempus Unlimited is the Financial Management Services entity. Tempus took over from Public Partnerships LLC on July 1, 2022. Tempus operates a participant-facing portal at pa.tempusunlimited.org and publishes annual maximum DCW hourly pay-rate sheets per CHC-MCO. The maximum rate is set by the CHC-MCO and varies by region; the participant cannot pay above the maximum but can pay below it (though competitive rates matter for recruiting and retaining workers). Pennsylvania does not have a state wage-parity statute for personal-care wages, so the wage floor is the Pennsylvania minimum wage and the ceiling is the MCO's published maximum.

The participant retains the federal Difficulty of Care exclusion under IRS Notice 2014-7 for live-in family Direct Care Workers, the same way other state self-directed Medicaid programs handle the exclusion. A live-in adult child paid as a DCW for a parent who shares the home can have the wages excluded from federal gross income, with the FMS reporting the exclusion in W-2 Box 12 Code II.

The Service Coordinator and the Person-Centered Service Plan

Every NFCE-HCBS and NFCE-NF participant is assigned a Service Coordinator by their CHC-MCO within 5 to 10 business days of enrollment. The Service Coordinator is the central operational figure in a CHC participant's care.

The Service Coordinator develops the Person-Centered Service Plan within 15 days of the comprehensive needs assessment. The PCSP must be based on the assessment, address physical, cognitive, and behavioral health needs, include explicit Medicare coordination for dual eligibles, document the participant's goals and risks, identify backup plans for each critical service (what happens if the Direct Care Worker does not show up), be provided in writing in the participant's preferred language, and be reassessed at least annually or sooner upon significant change in condition.

Service Coordinator Supervisors must be Pennsylvania-licensed Registered Nurses, Pennsylvania-licensed Social Workers, or Pennsylvania-licensed Mental Health Professionals with at least three years of relevant experience. Line-level Service Coordinators must hold a bachelor's degree in social work, nursing, or a related human-services field plus mandated training in person-centered planning, the Functional Eligibility Determination tool, and the CHC service array.

Service Coordinator caseload runs in the range of 1 to 60 to 1 to 90 participants for HCBS-track members and lower for high-acuity participants. Response timeframes per the CHC Agreement require a same-day response for urgent participant calls and a one-business-day response for routine calls.

Functional Eligibility: The FED, the Physician Certification, and the OLTL Medical Director

Functional eligibility for CHC NFCE-HCBS or NFCE-NF status is determined through a three-step clinical pathway.

Step one: the Functional Eligibility Determination. The FED is a Pennsylvania-specific instrument developed at the University of Pittsburgh, drawn as a subset of questions from the InterRAI Home Care assessment. The FED scores the applicant on activities of daily living (bathing, dressing, transferring, toileting, eating, continence), instrumental activities of daily living (meal preparation, medication management, financial management), cognitive status, and behavioral issues. A score above the threshold establishes Nursing Facility Clinical Eligibility. The FED must be administered within 15 days of CHC application. Pennsylvania's 52 Area Agencies on Aging serving the 67 counties (some AAAs cover multiple counties) administer the FED.

Step two: the physician certification. The applicant's physician completes Form MA-51, the OLTL-specific physician certification confirming the medical basis for nursing-facility level of care. The form is submitted alongside the AAA FED.

Step three: the OLTL Medical Director review. After the AAA assessment and the physician certification arrive, the OLTL Medical Director team reviews both documents along with any prior assessments from the past 12 months, the Service Coordinator notes for ongoing participants, and the most recent service plan. The OLTL Medical Director makes the final NFCE determination. This centralized review was implemented in part to address concerns about inconsistent NFCE determinations across plans.

Functional eligibility is recertified annually for ongoing CHC NFCE-HCBS participants using the same FED instrument. A determination of "no longer NFCE" triggers fair-hearing rights with aid-pending continuation if the participant requests a hearing within the 10-day window described below.

How to Enroll in Community HealthChoices Pennsylvania

The Pennsylvania Independent Enrollment Broker, operated by Maximus under contract with PA DHS, is the front door for CHC enrollment.

Phone: 1-844-824-3655. Hours: Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Time. Web: paieb.com.

The enrollment sequence for a family helping a parent into CHC from scratch:

1. Confirm Pennsylvania residency and rule out LIFE. If the senior is age 55 or older, lives within a LIFE provider's service area, and clears nursing-facility level of care, evaluate LIFE first as the integrated alternative.
2. Apply for Medical Assistance. File a PA-600 (or PA-600 LTC for nursing-facility-bound applicants) through COMPASS at compass.dhs.pa.gov, by phone at the Consumer Service Center 1-866-550-4355, or in person at the County Assistance Office.
3. Establish financial eligibility. The 2026 income limit for the 300% Special Income Level pathway is $2,982 per month; the asset limit is $8,000 (Tier One) or $2,400 (Tier Two); home equity is exempt up to the federal minimum of $752,000. Pennsylvania's Medically Needy spend-down is the path for applicants over the SIL and does not require a Miller Trust.
4. AAA functional assessment. Within 15 days of MA approval (sometimes proactively before), the AAA of the applicant's county administers the FED. Find the AAA through p4a.org/aaas or call the PA Department of Aging at 1-717-783-1550.
5. Physician certification. The applicant's physician completes Form MA-51 confirming nursing-facility level of care.
6. NFCE determination. The OLTL Medical Director reviews and issues the determination, typically within 14 to 30 days.
7. Enrollment packet from the IEB. Once NFCE is established (or NFI is confirmed), Maximus sends the enrollment packet listing the three MCO options. The applicant has 30 days to select. If no selection is made, the IEB default-assigns to one of the three MCOs based on existing PCP relationships, family-unit MCO assignments, and load balancing.
8. MCO selection. Compare the three plans on existing PCP and specialist participation, hospital affiliations, HCBS provider network depth, supplemental benefits, and Service Coordinator quality reputation in the region.
9. Service Coordinator and Person-Centered Service Plan. The chosen MCO assigns a Service Coordinator within 5 to 10 business days, who then conducts the comprehensive needs assessment and develops the PCSP within 15 days.
10. Ongoing care management. Annual functional reassessment, monthly Service Coordinator contact, quarterly PCSP reviews, and reassessment upon any significant change.

Default-assigned participants have a 90-day grace period to switch MCOs without needing a "just cause" reason. After the 90 days, participants can change MCOs anytime for just cause (network gaps, quality-of-care issues, marketing misrepresentation, longtime-PCP loss) or during the annual open-enrollment window in November for an effective date of January 1.

Continuity of Care: 60 Days, 180 Days, and Indefinite

The CHC Agreement and 31 Pa. Code § 154.15 require that when a CHC participant transitions to a new MCO (initial CHC enrollment, just-cause change, or annual open enrollment), the new CHC-MCO must allow the participant to continue using the same providers and continue receiving the same ongoing course of treatment for at least the first 60 days.

For NFCE-HCBS participants, the Continuity of Care period is extended to 180 days for HCBS service plans and HCBS providers. This was a deliberate transition-design feature to prevent disruption of established home-care arrangements when the legacy waivers folded into CHC, and it remains operative for new HCBS enrollees in 2026.

For nursing-facility residents, the Continuity of Care is indefinite: a Medicaid-paid nursing-facility resident is never forced to leave the facility because of a CHC-MCO transition. The new CHC-MCO must continue paying the same facility's per-diem unless the participant chooses to move or becomes ineligible for Medicaid. This is one of CHC's strongest consumer protections.

The CHC Agreement also requires CHC-MCOs to contract with "any willing provider" who meets credentialing standards within their service area for HCBS provider types. This is more permissive than typical Medicaid managed-care provider-network rules and reflects OLTL's commitment to preserving the breadth of the legacy fee-for-service HCBS provider base.

Grievances, Fair Hearings, and the PHLP Ombudsman

CHC participants have a layered appeal pathway when an MCO denies, terminates, or reduces a service.

Step one: the first-level grievance. Filed with the CHC-MCO. The MCO has 30 days to issue a first-level decision (72 hours for expedited cases where waiting would jeopardize the participant's life, health, or ability to regain maximum function).

Step two: the second-level grievance. Filed with the CHC-MCO if the participant disagrees with the first-level outcome. The MCO has another 30 days to issue a second-level decision.

Step three: the DHS Fair Hearing. Filed with the Bureau of Hearings and Appeals (BHA) under the authority of 55 Pa. Code Chapter 275, which governs recipient appeals. (Chapter 41, sometimes cited in error, governs provider appeals, not recipient appeals.) Federal managed-care rules under 42 CFR § 438 Subpart F also allow direct fair-hearing requests without exhausting the internal grievances; PA has implemented this flexibility.

The Fair Hearing window is 30 days from the mail date of the written notice of adverse action. The deadline is strict, so file early.

Aid-pending-appeal preserves services. If the participant requests a Fair Hearing within 10 days of the notice mail date AND requests aid pending, the MCO must continue services at the pre-reduction or pre-termination level until the Fair Hearing decision issues. If the participant loses the hearing, retroactive recoupment is theoretically available but rare in practice.

The Bureau of Hearings and Appeals is the DHS administrative tribunal, with regional offices in Harrisburg, Philadelphia, and Pittsburgh and field offices in Erie, Reading, and Plymouth. Hearings are typically conducted by phone or video by Administrative Law Judges; in-person hearings can be requested. BHA decisions are appealable to the Commonwealth Court of Pennsylvania within 30 days.

The Pennsylvania Health Law Project (PHLP) at 1-800-274-3258 is the de facto consumer ombudsman for CHC. PHLP is a 501(c)(3) public-interest law firm that provides free legal assistance and information on Medical Assistance, CHIP, Medicare, and related programs. PHLP represents consumers in eligibility disputes, service denials, MCO enrollment issues, estate-recovery cases, and Fair Hearings. The helpline is staffed Monday, Wednesday, and Friday from 8:00 a.m. to 8:00 p.m. Eastern Time. PHLP is independent of DHS, OLTL, and the MCOs. It is the single most useful free resource a Pennsylvania CHC family can call when something has gone wrong.

Key 2026 Facts

A handful of 2026-specific developments shape the operational picture.

The CHC waiver renewal effective July 1, 2026. The 1915(c) waiver renewal package was published in the Pennsylvania Bulletin on January 31, 2026, with a public-comment period that closed March 1, 2026. CMS approval is in process. The renewal continues the same operational architecture (three statewide MCOs, mandatory enrollment for the listed populations, same service array). The program is not threatened by an expiration cliff.

CMS-0057-F prior-authorization clocks effective January 1, 2026. The CMS Interoperability and Prior Authorization Final Rule tightens standard service-authorization decision windows, retains expedited and pharmacy clocks, and applies to Medicaid managed-care plans, including CHC. Verify the current numeric timeframes in the Final Rule and the CHC Agreement.

OBBBA Section 71117 provider-tax phase-in begins October 1, 2026. The federal One Big Beautiful Bill Act of July 4, 2025 imposes new uniformity-waiver requirements on state managed-care taxes. Pennsylvania has historically operated MCO taxes that contribute to state Medicaid revenue, and the new requirements may force restructuring. The CMS Center for Medicaid and CHIP Services Informational Bulletin issued November 18, 2025 provides initial implementation guidance. The PA-specific quantified impact on CHC capitation is not yet published as of this writing.

The 2024 CHC reprocurement remains operationally pending. The five plans selected in the 2024 RFA include the three incumbents plus Aetna Better Health Pennsylvania and Vista Health Plan. As of mid-2026 the new entrants are at varying stages of activation; the three incumbents continue to serve essentially all CHC members and continue to receive default assignments.

Personal Needs Allowance for nursing-facility residents is $60 per month. The PNA was raised from $45 to $60 effective January 1, 2025 (the first increase in 18 years) and remains at $60 in 2026.

Tempus Unlimited continues as the Financial Management Services entity for Services My Way participant-directed services, having taken over from PPL on July 1, 2022.

Common Misconceptions

The single most useful service this guide can provide is to flatly correct the misconceptions that show up on agency websites, in older directories, and in well-meaning advice that has not kept up with the rule changes.

• "CHC and HealthChoices are the same program." False. HealthChoices is the physical-health Medicaid managed-care program for non-LTC populations, in operation since 1997. Community HealthChoices is the LTSS program launched in 2018 to 2020. The names are confusingly similar, the populations are distinct, and the operational rules are different.
• "Spouses can be paid as caregivers in CHC." False in Pennsylvania. The legally-responsible-relative bar prohibits spouses from being paid as Direct Care Workers under Services My Way. Parents of adult disabled children age 21 and older can be paid; spouses cannot.
• "I/DD waivers are part of CHC." False. The Consolidated, Person/Family Directed Support, and Community Living waivers, plus the Adult Autism Waiver, run separately under the Office of Developmental Programs.
• "LIFE participants are also in CHC." False. LIFE participants are excluded from CHC. A senior on LIFE receives all care through the LIFE provider; they do not have a CHC-MCO.
• "CHC covers behavioral health." False. Behavioral health is carved out to a county-based BH-MCO under HealthChoices Behavioral Health. CHC enrollees have two MCOs and two ID cards.
• "There are five CHC plans now." Not operationally as of mid-2026. The 2024 RFA selected five plans, but the two new entrants are still in varying stages of activation. The three incumbents serve essentially all members.
• "If I don't pick a plan, I'll be without coverage." False. The IEB default-assigns the participant to one of the three MCOs if no selection is made. The participant has a 90-day grace period to switch.
• "I can't switch MCOs except in November." False. Annual open enrollment in November is the unrestricted window, but participants can change anytime for just cause, and default-assigned new enrollees have the 90-day grace period.
• "If my parent enters a nursing home, the MCO will move her to a different facility." False. Nursing-facility residents have indefinite Continuity of Care. The new CHC-MCO must continue paying the same facility's per-diem unless the participant chooses to move.
• "Continuity of Care is only 60 days." False. The 60-day general rule applies to most MCO transitions. HCBS service plans and HCBS providers receive 180 days. Nursing-facility residents have indefinite Continuity of Care.
• "55 Pa. Code Chapter 41 is the Fair Hearing chapter." False. Chapter 41 governs provider appeals. The CHC participant Fair Hearing chapter is 55 Pa. Code Chapter 275.

Frequently Asked Questions

Where to Go Next

For the underlying financial-eligibility rules that gate CHC, the Pennsylvania Medicaid eligibility and income limits guide covers the 2026 $2,982 SIL, the two-tier $8,000 / $2,400 asset structure, and the home-equity exemption. The how to apply guide walks through COMPASS, the Consumer Service Center, and the County Assistance Office paths. The Pennsylvania Medicaid pillar is the orientation hub for everything Medicaid in the Commonwealth.

For married couples, the spousal impoverishment guide covers the Community Spouse Resource Allowance and the Minimum Monthly Maintenance Needs Allowance. The medically needy spend-down guide explains the path for applicants over the SIL (Pennsylvania does not require a Miller Trust). The 5-year lookback and penalty divisor guide covers the institutional-Medicaid gift-and-transfer rules.

For paid-caregiver questions specific to Pennsylvania, the Pennsylvania paid family caregiver guide is the deep-dive companion to the Services My Way section above. The Pennsylvania caregiver pillar is the omnibus hub.

Learn More

• Pennsylvania Medicaid Programs Overview
• PA Medicaid Eligibility & Income Limits
• How to Apply for Pennsylvania Medicaid
• Pennsylvania LIFE Program (PACE)
• Pennsylvania Spousal Impoverishment
• PA Penalty Divisor & 5-Year Lookback

Find personalized help comparing Pennsylvania's Community HealthChoices plans at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.