Pennsylvania DEHQ State Report
In Pennsylvania, the state coordinates care for approximately 400,000 dual-eligibles through several systems, including Community HealthChoices (CHC), Behavioral HealthChoices, PACE/LIFE, and Dual-Eligible Special Needs Plans (D-SNPs). These programs are designed to ensure that individuals can receive medical care, behavioral health services, and long-term supports in a coordinated and cost-effective way-
Dual-eligibility refers to someone who qualifies for both Medicare and Medicaid coverage. They are often individuals with limited income that are either age 65 or older or under 65 with a qualifying disability. You can find more on the basics of dual-eligibility here.
In our latest Pennsylvania Dual-Eligible HQ State Report, published in April 2025, we dive into the details of dual-eligibility in Pennsylvania and how services are coordinated and delivered. You can find the most up-to-date information available on Pennsylvania dual-eligibles, including key program structures, eligibility details, payment models, and enrollment figures. It is intended to be a helpful reference for anyone looking to understand dual-eligibility in Pennsylvania, whether for policy planning, research, or program development.
In the Pennsylvania Dual-Eligible HQ State Report, you can find answers to questions like:
· How is Pennsylvania’s Medicaid system structured, and what role do managed care organizations (MCOs) play?
· What are the different types of Medicaid managed care programs in Pennsylvania?
· Who qualifies as a dual eligible in Pennsylvania, and what services do they receive?
· How do Community HealthChoices (CHC), D-SNPs, and LIFE/PACE work together to serve dual eligibles in PA?
· What is the difference between HealthChoices, Community HealthChoices, and Behavioral HealthChoices?
· How is care for dual-eligibles with long-term care, IDD, or behavioral health needs delivered in Pennsylvania?
· Who administers and oversees care for dual-eligibles in Pennsylvania?
· What are the latest dual eligible enrollment numbers in Pennsylvania?
· How do value-based payments play into the delivery of services to dual-eligibles in PA?
· What trends are emerging in dual-eligible enrollment and program participation across Pennsylvania?
Ready to learn more about dual-eligibility in PA? Download now!
