What PA Health & Wellness Community HealthChoices Is

PA Health & Wellness is a Pennsylvania Medicaid managed care plan operating within the Community HealthChoices (CHC) program. The state introduced CHC to the Southeast zone, including Philadelphia, Bucks, Chester, Delaware, and Montgomery counties, on January 1, 2019.

The CHC program serves adults 21 and older who either have both Medicare and Medicaid or who require long-term services and supports (LTSS). Participants enrolled in this plan receive coverage for their Medicaid physical health services.

If members apply and receive approval for the CHC waiver, the plan also covers non-medical home care. Waiver services include Personal Assistance Services, non-medical transportation, adult day health, Personal Emergency Response Systems (PERS), respite care, home-delivered meals, and home adaptations.

Is It Medicaid or Medicare?

PA Health & Wellness Community HealthChoices is a Medicaid program. It is not Medicare.

Many people enrolled in this plan are “dual-eligible,” meaning they qualify for both Medicare and Medicaid. The PA Health & Wellness Medicaid plan covers Medicaid physical health benefits and, if the member qualifies, long-term waiver services at home.

You must apply separately for the CHC waiver to receive home care. Simply having the PA Health & Wellness physical health plan does not automatically grant you Personal Assistance Services. People who do not need long-term care but are on Medicare and financially eligible for Medicaid apply for standard Medicaid through the County Assistance Office using the online COMPASS system or by calling 1-866-550-4355.

Getting Personal Assistance Services Through the Plan

Personal Assistance Services help your loved one with activities of daily living (ADLs), such as eating, bathing, and dressing. Caregivers also provide cueing and supervision for people who cannot safely be left alone. They assist with health maintenance, such as bowel and bladder routines, and routine support like meal planning. Caregivers can accompany the participant into the community for grocery shopping or visiting the pharmacy. Incidental homemaker tasks, such as washing linens and dishes from meal prep, are covered only when no one else is available to do them.

To get these personal care services funded by PA Health & Wellness, your loved one must complete the CHC waiver application process. The application process can take a few months, though it should not take more than 90 days. It involves these steps:

1. Call the Independent Enrollment Broker (IEB) at 1-877-550-4227 to start the application.
2. The IEB sends a Physician Certification form to the doctor, who should return it within five business days.
3. Meet with the IEB at home within seven business days of contact to begin the financial Medicaid application.
4. Complete a Functional Eligibility Determination (FED) during a second in-person visit within ten business days. An assessor from the Philadelphia Corporation for Aging (PCA) conducts this assessment.
5. Wait for the County Assistance Office (CAO) to review income, resources, and a five-year look-back period for asset transfers.

The FED checks whether your loved one is nursing facility clinically eligible. If the application is denied, the notice explains appeal rights.

Income and asset limits are the same for every CHC plan; see our CHC waiver guide.

Once approved, your loved one works with a service coordinator to create a person-centered service plan. This plan states exactly which services are approved and how many hours per week the plan covers. You can then select an agency to provide the care. Read more about how to apply for PA Medicaid home care.

If your family needs home care services in Philadelphia, call New Century Home Care at 215-974-0000. You can also fill out our online form and select “I am a client” followed by “I need services.” Our office staff speaks English, Russian, and Ukrainian.

Can a Family Member Be Paid Under This Plan?

Yes, family members can be paid to provide care under the CHC waiver, but there are strict rules about who qualifies.

According to a November 10, 2025 provider bulletin, PA Health & Wellness will not pay for services furnished by the participant’s spouse, legal guardian, representative payee, or Power of Attorney (POA). The state ended pandemic-era exceptions for these roles on May 11, 2023, and does not expect to make future exceptions.

If you hold one of these roles, you cannot be the paid caregiver. Adult children, siblings, or other relatives who are not the legal guardian or POA can typically work as paid caregivers. You can learn more about getting paid to care for a family member or read our specific guide on spouse and POA caregivers.

Caregivers working under the CHC waiver must comply with Electronic Visit Verification (EVV) requirements. Federal law requires states to use EVV for Medicaid personal care services to track when and where care occurs.

If your loved one chooses the participant-directed option, known as Services My Way, they act as the employer. Under this model, Tempus Unlimited serves as the fiscal agent handling worker enrollment, payroll, and tax reporting. Maximum participant-directed wage rates differ by region and by CHC plan.

Contact Details for CHC Programs

If you have questions about your benefits, eligibility, or legal rights, contact the appropriate organization below.

Switching To or From This Plan

Participants in the Community HealthChoices program can switch their managed care plan at any time. If you do not choose a plan, the state will auto-assign one to you.

If PA Health & Wellness does not meet your needs, you can change to another CHC plan, such as Keystone First CHC or UPMC Community HealthChoices. You can make this change by visiting www.enrollchc.com. Changing plans does not interrupt your underlying Medicaid waiver eligibility, but you may need to switch home care agencies if your current provider is not in the new plan’s network.

Working With New Century Under PA Health & Wellness Community HealthChoices

New Century Home Care is a licensed non-medical home care agency serving Philadelphia, Bucks, Montgomery, Delaware, and Chester counties. We provide companion care, personal care, homemaker services, mobility assistance, and respite care. Before a caregiver can begin working, Pennsylvania law requires agencies to conduct an interview, check at least two satisfactory references from non-relatives, and obtain a criminal history report.

Call us and we will check whether we can serve your loved one under PA Health & Wellness.

If you already care for a relative on this plan, call 215-974-0000 or visit our contact page to fill out the form, selecting “I am a caregiver” and “I already have a client.”