Individuals are eligible for Community HealthChoices if they are 21 years old or older, a resident of Pennsylvania, and either:
- Dually eligible for Medicare and Medical Assistance (with or without long-term services and supports [LTSS]); OR
- Eligible for Medical Assistance and qualify for LTSS because they need the level of care provided by a nursing facility.
Individuals are not eligible for Community HealthChoices if they are any of the following:
- An Act 150 program participant who is not dual eligible for Medicare and Medical Assistance.
- An individual with intellectual or developmental disabilities (ID/DD) who is eligible for services through DHS’ Office of Developmental Programs.
- A resident in a state-operated nursing facility, including the state veterans’ homes.
- An individual receiving OBRA Waiver LTSS.
You must have a Community HealthChoices managed care organization (CHC-MCO) or participate in the Living Independence for the Elderly (LIFE) program.
You may change your Community HealthChoices Managed Care Organization any time. You can choose one of two options to do so:
- Contact the state's Independent Enrollment Broker (IEB) at 1-844-824-3655. TTY users should call toll-free 1-833-254-0690.
- Change your CHC-MCO online at www.enrollchc.com.
They will tell you when your new Community HealthChoices plan will start. It can take up to six weeks for a change to your Community HealthChoices to take effect.
If you participate in the LIFE program, you can remain in the LIFE program. You will not be moved into Community HealthChoices unless you ask to change. If you are enrolled in Community HealthChoices and would rather participate in the LIFE program, you may do so if you qualify for LIFE.
UPMC Community HealthChoices does not decide if an individual is eligible for LTSS (long-term services and supports). A representative from the Area Agency on Aging or Aging Well assesses the person’s needs. The representative bases the decision on this assessment. Those who would like to apply for LTSS should contact the IEB at 1-877-550-4227 and request an assessment. (Please note the IEB phone number for LTSS enrollment is different from the one for Community HealthChoices enrollment.)
How to Apply