Improving Managed Care

Pennsylvania's mandatory care programs are called HealthChoices and Community HealthChoices (CHC).  HealthChoices is the managed care program for children under 21 and adults on Medicaid who do not require waiver services and are not on Medicare. Community HealthChoices (CHC) is the managed care program for individuals who are on both Medicare and Medicaid (sometimes called "dual eligibles"),  as well as individuals receiving Long-Term Services and Supports. 

As a Medicaid consumer, you have the right to choose your health plan based on plans available in your area, and you have the right to switch plans if you are unhappy with your plan. If you do not choose a plan, you will automatically be enrolled in one. In addition, you will be enrolled in a behavioral health plan that is selected by your county.

Nearly all populations covered by Pennsylvania’s Medicaid program are now enrolled in these risk-based managed care programs.  State policymakers have increasingly used managed care to stabilize program spending and coordinate care for beneficiaries.   What began as a narrow pilot program in the Southeast in 1997 is now statewide and covers practically all Medicaid recipients, including children, low-wage workers, adults with disabilities, dual-eligibles, and nursing facility residents. 

Since its inception, PHLP has fought to protect the rights of consumers in managed care.  Beyond representing clients in individual appeals, PHLP engages in systemic advocacy and represents Medicaid consumers before multiple statewide advisory committees.  We fight to cut through red tape and hold Pennsylvania's managed care plans accountable to the consumers they exist to serve. 

Portrait of senior woman looking from the balcony