Understanding MCOs and Your Choice
Managed Care Organizations (MCOs) play a pivotal role in providing Medicaid services. They are organizations contracted by Medicaid to offer healthcare services to enrollees. Understanding how MCOs work and the options available is crucial for ensuring the best care for yourself or your loved ones.
When choosing an MCO, consider factors like:
Available MCOs in Pennsylvania
Pennsylvania offers several strong options to choose from, each with unique benefits and services.
AmeriHealth Caritas
Known for its community-based approach and extensive behavioral health programs.
PA Health & Wellness
Features comprehensive care coordination for complex needs.
UPMC for You
Provides statewide hospital access and award-winning telehealth tools.
Step-by-Step Guide to Changing MCOs
Preparing to Change Your MCO
Before switching, review your current plan's services and compare them with other available options. Confirm that your healthcare needs and providers are covered by the new MCO.
Finding and Comparing MCOs
Use tools like PAMCO to compare AmeriHealth Caritas, PA Health & Wellness, UPMC for You, and other plans side-by-side. Look at provider networks, value-added benefits, and member satisfaction scores.
Enrolling in a New MCO
Once you've chosen a new plan, you can enroll by visiting the official DHS website or calling the Enrollment Services helpline.
1-844-824-3655
Resources for Navigating MCO Changes
Empowering You with Information and Assistance
For further assistance and resources on changing to plans such as AmeriHealth Caritas or UPMC for You, visit the official DHS website. Staying informed ensures a seamless transition and uninterrupted care.
MCO Frequently Asked Questions
What is a Managed Care Organization (MCO) in Pennsylvania?
A Managed Care Organization (MCO) is a private health insurance company that administers Pennsylvania Medicaid benefits — including in-home care — for enrolled members. Pennsylvania requires most Medicaid recipients to enroll in an MCO through the Community HealthChoices (CHC) program. Your MCO determines which providers you can use and manages your care authorizations.
Which MCOs in Pennsylvania cover Care Solutions of Pittsburgh?
Care Solutions of Pittsburgh works with the major MCOs operating in Allegheny County and Western Pennsylvania under the Community HealthChoices program, including UPMC Health Plan Community HealthChoices, PA Health & Wellness, and Centene/Keystone First CHC. Contact us at (412) 341-7780 to confirm coverage under your specific MCO.
Can I change my MCO in Pennsylvania if I want to use Care Solutions?
Yes — Pennsylvania Medicaid enrollees can change their MCO during open enrollment periods or for qualifying life events. If your current MCO does not include Care Solutions in its network, switching to an MCO that does can give you access to our services. Our team can help you understand your options and guide you through the change process.
What in-home care services does my MCO cover through Care Solutions?
Under Community HealthChoices, covered in-home services typically include personal care assistance, companion care, meal preparation, light housekeeping, medication reminders, and other home and community-based services. The specific services and authorized hours depend on your individual needs assessment and your MCO's care plan. Contact your MCO or call Care Solutions for details specific to your situation.
How do I get Care Solutions approved as my home care provider through my MCO?
Start by contacting your MCO's member services line to request an in-home needs assessment. Once your care needs are assessed and a plan is authorized, you can request Care Solutions of Pittsburgh as your provider. Our intake team works directly with MCO care coordinators to make enrollment as smooth as possible. Call us at (412) 341-7780 to get started.
Ready to Choose the Right MCO?
Seize the opportunity to make informed healthcare decisions with the MCO that best fits your family's needs. Apply so we can assist you today!
For medical emergencies, please call 911 immediately.