Court Says PA Must Redo Its Selection of Community HealthChoices Plans

What Happened?
On April 2, 2026, a Pennsylvania appeals court threw out the state’s recent selection of health plans for the Community Health Choices (CHC) program, known as the “reprocurement process”.  The court found that the Department of Human Services (DHS) did not follow its own rules when scoring health plan applications, deeming the state’s actions “arbitrary, capricious, and contrary to law.” The court ordered DHS to start the selection process over.

What is CHC?
Community HealthChoices is the Medicaid managed care program that serves over 400,000 older adults and people with disabilities across Pennsylvania.  The program, which launched in Pennsylvania in 2018, covers medical care, home and community-based services, and nursing facility care.. DHS currently has contracts with three health plans that administer the CHC program— UPMC Community HealthChoices (CHC), AmeriHealth Caritas/Keystone First CHC, and PA Health and Wellness CHC.

What went wrong with the selection process?
In 2024, DHS invited health plans to apply to run the CHC program in five regions across the state (the Northeast, Northwest, Lehigh/Capital, Southeast, and Southwest). Health plans could submit applications for one or more zones. The reprocurement rules required plans to explain in their application how they would serve each region's specific needs, and DHS was supposed to evaluate each region's applications separately.

Eight health plans applied to serve all five regions. DHS ultimately selected five applicants: the three existing CHC plans (Vista aka AmeriHealth Caritas/Keystone First, PA Health and Wellness, and UPMC CHC) and two new plans (Aetna Better Health and Health Partners Plans). But when DHS scored the applications, it gave each plan the exact same score across every region — even though the regions have very different populations and needs.

The Legal Challenge
Two health plans that were not selected, Highmark Wholecare and UnitedHealthcare, challenged the results in court. They argued the identical scores proved DHS either didn't evaluate the regions separately or didn't use region-specific criteria as required.

The court agreed, finding that DHS offered no rational explanation for the identical scores, and ruled the process was flawed. As a result, the court canceled the awards to the five plans that had been selected.

What This Means for CHC Participants
If you are currently enrolled in a CHC plan — or applying for CHC — nothing changes right now.  The three existing CHC plans, UPMC CHC, AmeriHealth Caritas/Keystone First CHC, and PA Health and Wellness, continue to operate as usual.

Your coverage, plan, and services are not affected by this court decision. DHS will need to redo the selection process, and we will keep you updated on any developments that could affect CHC participants in the future.