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Find out if you qualify for Community HealthChoices

To find out if you are eligible for Community HealthChoices (CHC), start with these questions.

Individuals age 21 and older are eligible for CHC if they are dually eligible for Medicare and Medicaid (with or without LTSS) or if they qualify for Medicaid long-term services and supports (LTSS) because they need the level of care provided by a nursing facility.
Are you eligible for Community HealthChoices?
  • Are you 21 or older?
    • Yes
      • Do one of these two options apply to you?
        1. You are eligible for both Medicare and Medicaid.
        2. You qualify for Medicaid long-term services and supports (LTSS) because you need the level of care provided by a nursing facility.
      • If you answered yes to either option and you live in one of these PA counties:
        • Allegheny
        • Armstrong
        • Beaver
        • Bedford
        • Blair
        • Bucks
        • Butler
        • Cambria
        • Chester
        • Delaware
        • Fayette
        • Greene
        • Indiana
        • Lawrence
        • Montgomery
        • Philadelphia
        • Somerset
        • Washington
        • Westmoreland
        You may qualify for CHC. Check the list below to make sure.
    • No
      • Sorry, you do not qualify for Community HealthChoices.

Additionally, you do not qualify for CHC if you are:

  • An Act 150 program participant.
  • A person 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.

If you are eligible for CHC Community HealthChoices

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.

Who decides if someone is clinically eligible for LTSS?

UPMC Community HealthChoices does not decide if an individual is eligible for LTSS. 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
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