Blog - CareChoice Home Care

When your loved one enrolls in Community HealthChoices for Medicaid home care services in Philadelphia, one of the first things that happens is they get assigned to a Managed Care Organization. Most families barely register this step. They receive a letter, glance at the name, and move on. That’s a mistake — because your MCO shapes nearly every aspect of your home care experience, from how quickly services start to how smoothly your family caregiver gets paid.

Three MCOs operate in Philadelphia’s Southeast Zone. Here’s what each one does, how they differ, and what your family should consider before accepting an assignment.

What an MCO Actually Does

A Managed Care Organization is the company that administers your loved one’s Medicaid benefits under Community HealthChoices. Think of the MCO as the gatekeeper and the coordinator. They assign your service coordinator — the person who conducts or arranges the functional assessment and develops your loved one’s care plan. They authorize services — determining what types of care your loved one receives and how many hours are approved. They manage the provider network — the agencies, caregivers, and vendors that deliver services. And they handle grievances and appeals when something goes wrong.

The MCO is your family’s primary point of contact within the CHC system. When you have a question about your loved one’s care plan, when you need hours adjusted, when a paycheck issue needs resolving, when you want to switch from agency-based care to Participant-Directed Services — the MCO is who you call.

The Three MCOs in the Southeast Zone

AmeriHealth Caritas Community HealthChoices

AmeriHealth Caritas is one of the largest Medicaid managed care companies in the Mid-Atlantic region and has deep roots in Philadelphia specifically. Their parent organization, Independence Health Group, has been part of the Philadelphia healthcare landscape for decades.

AmeriHealth Caritas tends to have a large provider network in the Philadelphia area, which can mean more options when selecting home care agencies or connecting with community resources. Their service coordination teams have significant experience with the Southeast Zone’s population, including the diverse cultural and language needs of Philadelphia’s neighborhoods.

Families who have worked with AmeriHealth Caritas often cite the size of their network as a strength — there are usually multiple options available for any given service. The trade-off that sometimes comes with size is that individual attention can vary depending on your assigned service coordinator. Like any large organization, the experience can be highly dependent on the specific people handling your case.

Keystone First Community HealthChoices

Keystone First CHC is also part of the Independence Blue Cross family, giving it strong institutional ties to the Philadelphia market. Keystone First has a long history in Medicaid managed care in Pennsylvania, predating the CHC program.

Keystone First’s familiarity with the Philadelphia Medicaid population is a notable strength. Their teams have been navigating the local system for years, and many of their service coordinators have deep knowledge of the resources available in specific Philadelphia neighborhoods — from community health centers to senior services to housing supports.

Families working with Keystone First often describe the experience as feeling somewhat more personalized, though this varies by caseload and coordinator. Their provider network in the Southeast Zone is robust, and they have established relationships with many of the home care agencies operating in the region.

PA Health & Wellness

PA Health & Wellness is part of Centene Corporation, one of the largest Medicaid managed care companies in the country. While Centene brings national scale and resources, PA Health & Wellness is specifically focused on the Pennsylvania market.

PA Health & Wellness entered the CHC landscape alongside the other two MCOs and has built its Southeast Zone presence from the ground up. Their national infrastructure can be a strength in areas like technology platforms, care management tools, and access to specialized programs that benefit from scale.

Some families find that PA Health & Wellness offers competitive responsiveness, particularly because they may have smaller caseloads per coordinator compared to the more established local MCOs — though this can shift as enrollment grows. Their provider network continues to develop and is generally comparable to the other two MCOs for core home care services.

How to Choose — Or How to Change

When your loved one first enrolls in CHC, they may be automatically assigned to an MCO. However, they have the right to choose a different one. The Pennsylvania Enrollment Services Line at 1-844-824-3655 handles MCO selection and changes. During the initial enrollment period, your loved one can select their preferred MCO. After enrollment, they can request a change during the annual open enrollment period or at certain other times.

If your loved one has already been assigned and you’re unhappy with the experience, don’t assume you’re stuck. Ask about your options for switching.

What to Ask When Evaluating Your MCO

Not every family will have the same priorities, but these questions help you evaluate whether your assigned MCO is the right fit.

How quickly will a service coordinator be assigned? Some MCOs assign a coordinator within days of enrollment. Others take weeks. The coordinator is your family’s lifeline within the system, so delays here cascade into delays everywhere else.

Does the service coordinator proactively offer Participant-Directed Services? This is a revealing question. If your family wants a relative to become the paid caregiver, the service coordinator should explain PDS during care planning — not wait for you to ask. Some MCOs train their coordinators to present PDS as a standard option. Others default to the traditional agency model unless the family specifically requests otherwise. An MCO that actively supports PDS is an MCO that respects family choice.

How responsive is member services? Call the MCO’s member services line before you commit. See how long you wait. See whether the person who answers can actually help you or just transfers you. This ten-minute test tells you more about the MCO than any brochure.

What’s the authorization process like? When your loved one’s care plan is developed and services are authorized, how transparent is the MCO about what’s approved and why? Can you get a clear explanation of how many hours were authorized and what services are included? If the authorization seems insufficient, does the MCO explain the appeal process?

Does the MCO have experience with your loved one’s specific needs? If your family member has a physical disability, a cognitive condition, or specific cultural and language needs, ask whether the MCO has coordinators with relevant expertise. A coordinator who understands dementia care, for example, will develop a different — and better — care plan than one who treats every case the same.

The MCO Isn’t Everything — But It’s the Foundation

Your MCO doesn’t provide the hands-on care. Your family caregiver does that, or a home care agency does. But the MCO controls the infrastructure around that care — the authorizations, the hours, the coordination, the problem-solving. A good MCO makes the system work for your family. A bad MCO makes the system feel like it’s working against you.

CareChoice works with all three MCOs in the Southeast Zone and can help your family navigate the strengths and limitations of whichever one you’re enrolled with. If you’re unsure which MCO is the best fit, or if you’re considering a switch, we can share what we’ve seen from working with hundreds of families across all three.

Get guidance from CareChoice → Contact our Philadelphia team

Understanding Managed Care Organizations for Home Care in Philadelphia