This section of PALawHelp.org has information and resources about Managed Care issues in Pennsylvania.
Click on a resource category listed below to see information related to that category.
Accessing Home and Community-Based Services When Income Appears Too High
People with income no more than $500 over the monthly income limit for the Community HealthChoices (CHC) Waiver, other home and community-based services waivers, or LIFE program may be eligible for a Waiver or LIFE program using a qualified Income Spend Down Trust. This fact sheet explains how to use an Income Spend Down Trust to qualify for a Waiver or LIFE program, even if income is above the program income limit. (February 2026)
Accessing the Community HealthChoices Waiver: A Guide to Waiver Eligibility for Advocates
This guide provides an overview of the application process for the Community HealthChoices waiver – including the functional eligibility review and the County Assistance Office (CAO) financial eligibility review. To qualify, applicants must be aged 21 or older and meet both functional and financial eligibility standards. Functional eligibility is determined by looking at a person’s ability to perform certain activities and tasks that are needed for daily living. Financial eligibility is determined by looking at a person’s income and resources (assets), such as bank accounts, property, and retirement accounts. (February 2026)
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
How to Appeal a Denial in Community HealthChoices
If your Community HealthChoices (CHC) managed care plan denies your request for a service, such as personal assistance services, you have the right to appeal. You can also appeal if your plan stops or reduces a service you have been getting. If your plan says the service you want is “not medically necessary,” this explains how to appeal that determination (June 2024)
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Writing a Letter of Medical Necessity for Personal Assistance Services (PAS): A Guide for Health Care Providers
This brochure explains how to write a strong letter of medical necessity to support your patient’s request or appeal involving Personal Assistance Services (PAS). It includes a list of topics to include in your letter and some sample language that may be useful in explaining your medical opinion. (August 2022)
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org. The Toll Free Helpline is open on Mondays and Wednesdays beginning at 8:00 AM Eastern.
Writing a Letter of Medical Necessity for Personal Assistance Services (PAS): A Guide for Health Care Providers
This brochure explains how to write a strong letter of medical necessity to support your patient’s request or appeal involving Personal Assistance Services (PAS). It includes a list of topics to include in your letter and some sample language that may be useful in explaining your medical opinion. (August 2022)
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
BE YOUR OWN BEST ADVOCATE: A Toolkit for Representing Yourself in Personal Assistance Services (PAS) Appeals
If you had an assessment and your Community HealthChoices (CHC) plan has denied or reduced your Personal Assistance Services (PAS) hours, you should file an appeal to challenge the decision. This toolkit highlights the most important information to present during your PAS appeal, and shares questions that you and your caregiver(s) should address as you prepare for and present your case during the appeal. (July 2025)
Accessing Drug & Alcohol Treatment Services in HealthChoices: Know Your Rights
Information for consumers using HealthChoices seeking to access drug and alcohol services or have an assessment to determine if treatment is needed.
Accessing Home and Community-Based Services When Income Appears Too High
People with income no more than $500 over the monthly income limit for the Community HealthChoices (CHC) Waiver, other home and community-based services waivers, or LIFE program may be eligible for a Waiver or LIFE program using a qualified Income Spend Down Trust. This fact sheet explains how to use an Income Spend Down Trust to qualify for a Waiver or LIFE program, even if income is above the program income limit. (February 2026)
Accessing the Community HealthChoices Waiver: A Guide to Waiver Eligibility for Advocates
This guide provides an overview of the application process for the Community HealthChoices waiver – including the functional eligibility review and the County Assistance Office (CAO) financial eligibility review. To qualify, applicants must be aged 21 or older and meet both functional and financial eligibility standards. Functional eligibility is determined by looking at a person’s ability to perform certain activities and tasks that are needed for daily living. Financial eligibility is determined by looking at a person’s income and resources (assets), such as bank accounts, property, and retirement accounts. (February 2026)
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
How to Appeal a Denial in Community HealthChoices
If your Community HealthChoices (CHC) managed care plan denies your request for a service, such as personal assistance services, you have the right to appeal. You can also appeal if your plan stops or reduces a service you have been getting. If your plan says the service you want is “not medically necessary,” this explains how to appeal that determination (June 2024)
How to Make a Complaint to Your MA Managed Care Plan
This fact sheet from the Pennsylvania Health Law Project describes the process for filing a complaint with your managed care plan about a participating provider, or about the coverage, operations, or management of the plan, and what to do if you are not satisfied with the complaint outcome. (September 2020)
Medical Assistance Managed Care in Pennsylvania - A Guide to Pennsylvania’s HealthChoices Program for Families
This guide explains the basics of Medical Assistance (MA) Physical Health coverage for children in Pennsylvania through the HealthChoices Program. (May 2014)
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org. The Toll Free Helpline is open on Mondays and Wednesdays beginning at 8:00 AM Eastern.
Southeastern PA Consumer Guide: Where to Call for Help With Community HealthChoices
Information on where consumers in southeast Pennsylvania can get help with problems with Community HealthChoices. (March 2019)
Troubleshooting Service Coordination Problems in Community HealthChoices - A Toolkit for CHC Participants
This self-help guide from Pennsylvania Health Law Project is designed to help Community HealthChoices participants with common issues with their service coordinators. It includes instructions on how to file a complaint.
Writing a Letter of Medical Necessity for Personal Assistance Services (PAS): A Guide for Health Care Providers
This brochure explains how to write a strong letter of medical necessity to support your patient’s request or appeal involving Personal Assistance Services (PAS). It includes a list of topics to include in your letter and some sample language that may be useful in explaining your medical opinion. (August 2022)
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Pennsylvania Health Care Facilities Search
Search aid from the Pennsylvania Department of Health to help you locate health facilities in Pennsylvania.
BE YOUR OWN BEST ADVOCATE: A Toolkit for Representing Yourself in Personal Assistance Services (PAS) Appeals
If you had an assessment and your Community HealthChoices (CHC) plan has denied or reduced your Personal Assistance Services (PAS) hours, you should file an appeal to challenge the decision. This toolkit highlights the most important information to present during your PAS appeal, and shares questions that you and your caregiver(s) should address as you prepare for and present your case during the appeal. (July 2025)
Writing a Letter of Medical Necessity for Personal Assistance Services (PAS): A Guide for Health Care Providers
This brochure explains how to write a strong letter of medical necessity to support your patient’s request or appeal involving Personal Assistance Services (PAS). It includes a list of topics to include in your letter and some sample language that may be useful in explaining your medical opinion. (August 2022)