What UPMC Community HealthChoices is

UPMC Community HealthChoices is a Medicaid managed care plan offered under Pennsylvania’s Community HealthChoices (CHC) program. The CHC program serves adults 21 and older who require long-term services and supports (LTSS) or who have both Medicare and Medicaid.

In the Southeast zone—which covers Philadelphia, Bucks, Chester, Delaware, and Montgomery counties—UPMC is one of three available CHC plans. The other two options are AmeriHealth Caritas (locally branded as Keystone First CHC) and Pennsylvania Health & Wellness.

The CHC program provides physical health coverage, but participants who need in-home care must separately apply for the Pennsylvania CHC waiver program. If approved, the waiver covers services such as adult day health, home-delivered meals, assistive technology, and Personal Assistance Services.

Is it Medicaid or Medicare?

UPMC Community HealthChoices is a Medicaid plan, not a Medicare plan. While the plan covers Medicaid physical health benefits and waiver services, it does not replace Medicare.

Many individuals enrolled in UPMC Community HealthChoices are “dual-eligible.” This means they receive their primary medical coverage through Medicare, while their CHC plan handles their Medicaid physical health benefits. Because Medicare does not cover long-term non-medical home care, dual-eligible individuals rely on the CHC waiver to pay for daily in-home assistance.

Getting Personal Assistance Services through the plan

Personal Assistance Services provide hands-on help with eating, bathing, dressing, and routine support like meal planning. To access these services, your loved one must apply for the CHC waiver. The application involves several steps:

1. Call the Independent Enrollment Broker (IEB): Start by calling the IEB at 1-877-550-4227 to begin the process.
2. Physician Certification: The IEB sends a form to your loved one’s doctor, who must return it within five business days.
3. Functional Assessment: An assessor from the local Area Agency on Aging (which is the Philadelphia Corporation for Aging in Philadelphia) visits to complete a Functional Eligibility Determination (FED). The FED assesses cognition and the need for hands-on help with activities of daily living. Help with shopping or housekeeping does not count toward this determination.
4. Financial Review: The County Assistance Office (CAO) reviews the applicant’s finances. For 2026, the monthly income limit is $2,982. The CAO also checks resources and reviews any financial transfers made in the past five years.
5. Service Planning: Once the CAO approves the application, the CHC plan assigns a service coordinator. The coordinator works with your family to create a person-centered service plan (PCSP) outlining the approved services and hours.

If eligibility or a service is denied, the written notice explains the appeal rights; PHLP gives free help with appeals.

If you need help understanding the home care process, call New Century Home Care at 215-974-0000. You can also reach out online by selecting “I am a client” and “I need services” on our secure online contact form.

Can a family member be paid under this plan?

Yes, family members can get paid to provide Personal Assistance Services for a relative enrolled in UPMC Community HealthChoices. However, the CHC waiver will not pay the participant’s spouse, legal guardian, representative payee, or power of attorney (POA). Pandemic-era exceptions for these roles ended on May 11, 2023. You can find more details on our rules for spouses and POAs page.

If you qualify to be a caregiver, state law requires you to pass a criminal history report and complete a tuberculosis (TB) screening before you begin providing care. Caregivers must also meet competency requirements, which can be fulfilled by passing an agency exam or completing a recognized training program.

Families can choose between an agency model or a participant-directed option called Services My Way. Under Services My Way, the participant acts as the employer, and a vendor called Tempus Unlimited handles payroll and taxes. Under the agency model, the caregiver is hired and paid directly by a licensed home care agency. For more information on the steps involved, read our guide on getting paid to care for family.

Contact details

Use the table below to find the right organization for your Medicaid and home care needs. For detailed rules on eligibility, you can also review the PHLP 2026 CHC waiver guide.

Switching to or from this plan

Participants in the Pennsylvania CHC program have the right to switch their health plan at any time. If your loved one is auto-assigned to a plan they do not want, or if they wish to move between UPMC, Pennsylvania Health & Wellness, and AmeriHealth Caritas, they can do so.

Plan changes are managed through the state’s enrollment website at www.enrollchc.com. If you are also looking to change the agency that provides your daily care, review our guide on how to switch your home care agency.

Working with New Century under UPMC Community HealthChoices

New Century Home Care is a licensed non-medical home care agency. We provide companion care, mobility assistance, homemaker services, and specialized support for conditions like dementia and Parkinson’s.

Call us and we will check whether we can serve your loved one under UPMC CHC.

For family members seeking employment as caregivers, we offer weekly pay, direct deposit, paid sick days, holiday pay, and a $350 signing bonus. Our office staff speaks English, Russian, and Ukrainian.

To discuss your loved one’s care plan or to apply for a caregiver position, call New Century Home Care at 215-974-0000. Caregivers can also apply online by selecting “I am a caregiver” and “I already have a client” on our contact form.