Who is eligible for UPMC Community HealthChoices?

The Department of Human Services (DHS) determines who is eligible for UPMC Community HealthChoices.

Individuals are eligible for UPMC Community HealthChoices if they are 21 years old or older, live in Pennsylvania and:

• Dual eligible for Medicare and Medical Assistance (with or without LTSS); OR
• Eligible for Medical Assistance and qualify for LTSS because they need the level of care provided by a nursing facility.

Individuals are not eligible for UPMC Community HealthChoices if they are one of the following:

• An individual with intellectual or developmental disabilities (ID/DD) who is eligible for services through DHS’ Office of Developmental Programs.
• A resident in a state-operated nursing facility, including the state veterans’ homes.

Eligibility for long-term services and supports (LTSS)

UPMC Community HealthChoices does not decide if an individual is eligible for LTSS. A representative from the Area Agency on Aging or Aging Well assesses the individual’s needs.

Learn more about how to enroll in UPMC Community HealthChoices or how to request a LTSS assessment.