PA Health and Wellness

What PA Health and Wellness does

PA Health and Wellness is a Pennsylvania-based Managed Care Organization and wholly-owned subsidiary of Centene Corporation (NYSE: CNC), operating exclusively within the state of Pennsylvania. The company delivers a four-line health plan portfolio: Community HealthChoices (CHC), a Medicaid managed long-term services and supports plan serving individuals with physical disabilities, intellectual/developmental disabilities, and dual-eligible populations across the state's five CHC zones covering nearly 400,000 lives; Medicare Advantage plans marketed under the Allwell brand; ACA Marketplace plans under the Ambetter brand offered through the Pennie exchange (expanding into nine additional counties for the 2026 plan year via a Geisinger Health System partnership); and WellKids by PA Health and Wellness, the state's Children's Health Insurance Program covering uninsured children under 19 across free, low-cost, and full-cost premium tiers. Its operational footprint is anchored at 1700 Bent Creek Blvd., Mechanicsburg, PA, with a field network of Service Coordination Entities supporting Medicaid enrollment and care coordination.

The company's technology platform is built on Centene's enterprise managed-care infrastructure and includes HIPAA-compliant PHI handling across oral, written, and electronic channels, a federal Interoperability and Patient Access API for member data access via third-party apps, member and provider self-service portals, a mobile app with digital ID cards, and the Softheon-powered premium payment gateway for CHIP. Key third-party integrations include Express Scripts for pharmacy network and claims processing (CHIP), Evolent Health (National Imaging Associates) for imaging benefit management and prior authorization, Krames for patient education content, and a 2025-partnered virtual care capability with Vheda Health for chronic-condition management. The provider-facing portal supports eligibility verification, claims management, prior authorization, and care gap closure workflows under HEDIS quality reporting. Two third-party vendor privacy incidents (Insightin Health and Berkeley Research Group) are disclosed on the public site, indicating active vendor risk management obligations.

PA Health and Wellness generates revenue primarily through capitation payments from the Pennsylvania Department of Human Services for Medicaid CHC and Medical Assistance contracts, supplemented by monthly Medicare Advantage premiums (Allwell), ACA Marketplace premiums via Ambetter/Pennie, and CHIP premiums. Distribution combines state-contracted enrollment (Medicaid/CHIP), direct-to-consumer online self-serve enrollment (Ambetter, Allwell), broker channels for Marketplace products, and direct field-based service coordination entities for Medicaid. Because PA Health and Wellness is a wholly-owned subsidiary of Centene Corporation, no independent funding rounds apply, no founder equity exists, and financial metrics are not separately disclosed; the entity derives strategic and operational scale from its parent's Fortune 500 infrastructure but is currently exposed to a court-ordered re-bidding of its Community HealthChoices contracts following a 2026 Pennsylvania appeals court ruling.

Name

PA Health and Wellness

Legal name

PA Health and Wellness

Website

https://pahealthwellness.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

501–1,000 employees

Short description

PA Health and Wellness is a Pennsylvania-based managed care organization and wholly-owned subsidiary of Centene Corporation, providing Medicaid (Community HealthChoices), Medicare Advantage (Allwell), Marketplace (Ambetter), and CHIP (WellKids) health plans exclusively to Pennsylvania residents.

Ownership category

akta.pro rank

Product category

Managed Care Health Insurance

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Services for the Elderly and Persons with Disabilities (624120), Services for the Elderly and Persons with Disabilities (62412), Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (62331), Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (6233), Ambulatory Health Care Services (621)

SIC

Services-Health Services (8000)

akta.pro primary industry

Humanitarian Health Coordination & Emergency Response Partnerships (HLAJAOAI)

akta.pro secondary industries

Health Systems Strengthening & Universal Health Coverage (UHC) Partnerships (HLAJAOAL), Maternal, Child & Family Health Departments (HLAJAAAK)

Keywords

• Medicaid managed care
• Health insurance plans
• Long-term services supports
• Medicare Advantage plans
• Children's health insurance

Headquarters

HQ city

Camp Hill

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicaid Managed Care Contracts: Capitation payments from Pennsylvania Department of Human Services for Community HealthChoices (LTSS for ~400,000 people) and standard Medical Assistance members.
2. Medicare Advantage Premiums: Monthly premium revenue from Medicare Advantage plans offered through Allwell brand in Pennsylvania.
3. Health Insurance Marketplace (Ambetter): Premium revenue from Ambetter Marketplace plans offered through Pennie for the 2026 plan year in Pennsylvania.
4. CHIP Premiums: WellKids by PA Health and Wellness offers free, low-cost (subsidized), or full-cost CHIP coverage for children under 19 in Pennsylvania, with monthly premiums and copays for higher-income families.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels8 records

Core offering

PA Health and Wellness is a Pennsylvania Managed Care Organization that delivers government-sponsored and commercial health insurance plans to Pennsylvania residents. Its product portfolio includes Community HealthChoices (Medicaid managed long-term services and supports), Medicare Advantage marketed as Allwell, ACA Marketplace plans under the Ambetter brand, and the WellKids Children's Health Insurance Program (CHIP). Services are supported by member and provider self-service portals, care coordination, pharmacy and imaging benefit management integrations, and a HEDIS quality program.

Product overview

PA Health and Wellness is a Managed Care Organization and subsidiary of Centene Corporation that delivers Pennsylvania Medicaid and health insurance plans through a multi-product portfolio rather than a single product. Its flagship offering is Community HealthChoices (CHC), a Medicaid managed long-term services and supports (LTSS) plan, complemented by three parallel lines of business: Medicare Advantage (marketed as Allwell), the Ambetter Health ACA marketplace plan (expanded statewide for 2026 via a Geisinger partnership), and WellKids by PA Health and Wellness (CHIP) for uninsured Pennsylvania children. All four products share a common platform of member and provider self-service portals (Member Portal, Provider Portal, Find a Provider directory, and the PA Health & Wellness Mobile App), as well as back-office modules such as the Interoperability and Patient Access API, the Softheon-powered premium payment gateway for CHIP, the Express Scripts pharmacy network integration, and an Evolent Health (National Imaging Associates) imaging benefit management integration. The portfolio is further supported by a Virtual Care partnership with Vheda Health for chronic-condition management, a HEDIS quality program, and the Caregiving Collaborations® caregiver support resources for CHC participants.

Differentiator

Problem solved

Functional benefit

Brands

• WellKids by PA Health and Wellness: Pennsylvania Children's Health Insurance Program (CHIP) plan offered by PA Health and Wellness for children under 19, including medical, dental, and vision benefits.

Products and services

• Community HealthChoices (CHC) PA Medicaid managed care plan covering long-term services and supports (LTSS), physical health, behavioral health, and home- and community-based services for eligible Pennsylvanians. Operates in five zones under Pennsylvania's Community HealthChoices program and serves dual-eligible and Medicaid-only populations.
• Medicare Advantage (Allwell by PA Health & Wellness) Medicare Advantage health plan for Pennsylvania Medicare beneficiaries, offered by PA Health and Wellness (a Centene subsidiary) and marketed under the 'Allwell' brand through a dedicated member portal.
• Ambetter Health (PA) Health insurance marketplace product offered by PA Health and Wellness on the Pennsylvania Pennie exchange. For the 2026 plan year it expanded into nine additional Pennsylvania counties through a partnership with Geisinger Health System, and includes telehealth, wellness rewards, and online enrollment.
• WellKids by PA Health and Wellness (CHIP) PA Health and Wellness's CHIP plan providing health coverage for uninsured Pennsylvania children under 19 not eligible for Medical Assistance. Includes medical, dental, vision, and pharmacy benefits, Bright Futures well-child visits, and a member handbook published in six languages for the 2026 plan year.

Quantifiable outcome

• Community HealthChoices program costs more than $7 billion in the upcoming fiscal year
• +2 more outcomes

Segments5 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

Feature4 records

Partnerships

Six partnerships are on record, tiered flagship, important, core and minor.

• Geisinger Health SystemflagshipGTM or Marketing Partner · 3 November 2025Ambetter Health (Centene product) partnered with Geisinger Health System to expand into nine additional Pennsylvania counties through Pennie for the 2026 plan year. Plans include comprehensive benefits, online enrollment, wellness rewards, and telehealth services.
• Vheda HealthimportantStrategic or Co-development Partner · 26 August 2025PA Health & Wellness partnered with Vheda Health to enhance virtual care services for participants with chronic conditions. The partnership aims to advance virtual care delivery for chronic condition management.
• Express ScriptscoreTechnology or IntegrationExpress Scripts serves as the pharmacy network and billing partner for WellKids by PA Health and Wellness CHIP. Provides contracted pharmacy network across Pennsylvania, 90-day extended day supply for maintenance medications, and pharmacy claim processing (BIN: 003858, PCN: MACP, GRP: 2FBA for CHIP).
• Berkeley Research Group (BRG)minorImplementation/ SI/ Consulting PartnerBerkeley Research Group (BRG) is a vendor that experienced a privacy incident impacting PA Health and Wellness participants.
• Centene CorporationflagshipStrategic or Co-development PartnerPA Health and Wellness is a subsidiary of Centene Corporation, a Fortune 500 managed care company. Centene provides corporate infrastructure, technology platforms, and shared services.
• Pennsylvania Department of Human Services (DHS)flagshipOthersPA Health and Wellness contracts with Pennsylvania DHS to provide Medicaid managed care services including Community HealthChoices (LTSS), Medical Assistance, and CHIP.

Scale indicators5 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Humana: National Medicare Advantage leader with strong Pennsylvania MA presence. Comparable to PA Health and Wellness's Allwell Medicare Advantage product in target population and benefit design.
• Anthem Blue Cross Blue Shield of Pennsylvania: Elevance Health's broad Pennsylvania health plan offering commercial, Medicare, and Medicaid products. Overlaps with PA Health and Wellness in Marketplace and Medicare Advantage segments.

Direct peers

• AmeriHealth Caritas Pennsylvania: Direct Medicaid managed care competitor in Pennsylvania operating Keystone First and Community HealthChoices contracts. Highly comparable product mix, target population, and contract structure to PA Health and Wellness.
• UPMC Health Plan: Pennsylvania-based integrated health plan offering Medicaid (UPMC for You), Medicare Advantage, and Marketplace products. Comparable multi-product managed care portfolio and overlap in Community HealthChoices zones.
• Highmark Wholecare (formerly Gateway Health): Pennsylvania Medicaid and Medicare managed care plan, a Highmark subsidiary, operating in Community HealthChoices zones. Direct competitor in the same CHC and Medical Assistance procurements.
• Aetna Better Health of Pennsylvania: CVS Health-owned Medicaid MCO serving Pennsylvania Medicaid and Community HealthChoices members. Competes head-to-head with PA Health and Wellness in state contracts and dual-eligible populations.
• UnitedHealthcare Community Plan of Pennsylvania: UnitedHealth Group's Medicaid managed care subsidiary in Pennsylvania, participating in Community HealthChoices and Medical Assistance. Direct procurement competitor with comparable scale and product breadth.
• Molina Healthcare of Pennsylvania: Molina Healthcare's Pennsylvania Medicaid MCO offering Medical Assistance and Medicare products. Direct competitor in state Medicaid managed care procurement with similar low-income focus.

Others

• Centene Corporation (other state Medicaid subsidiaries): Corporate parent and sibling managed care subsidiaries (e.g., Buckeye Health Plan, Sunshine Health) that share infrastructure, technology, and managed care playbook with PA Health and Wellness.

Regional players

• Kaiser Permanente Mid-Atlantic: Integrated health system with mid-Atlantic presence offering commercial and Medicare plans. Adjacent regional player in Pennsylvania with overlapping Medicare Advantage and commercial product sets.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/PAHandW
• YouTubeyoutube.com/@PAHealthandWellness/videos
• Facebookfacebook.com/PA-Health-Wellness-1022022034500543
• LinkedInlinkedin.com/company/pa-health-wellness

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about PA Health and Wellness