AmeriHealth Caritas Pennsylvania Community HealthChoices

Name

AmeriHealth Caritas Pennsylvania Community HealthChoices

Legal name

AmeriHealth Caritas Pennsylvania Community HealthChoices

Website

https://amerihealthcaritaschc.com

Company type

Private

Founded year

2018

Operating status

Operating

Ownership category

akta.pro rank

Product category

Medicaid Managed Care Health Plan

NAICS

Services for the Elderly and Persons with Disabilities (62412), Home Health Care Services (62161), Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (62331)

SIC

Hospital & Medical Service Plans (6324), Services-Home Health Care Services (8082), Services-Nursing & Personal Care Facilities (8050)

akta.pro industry

PRIMARYHLAEAEAI

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans

Healthcare & Life Sciences/Health Insurance & Managed Care/Medicaid Managed Care (MMC) Plans

SECONDARYHLAEALAG

Care Management & Population Health Program Administration

Healthcare & Life Sciences/Health Insurance & Managed Care/Third-Party Administration (TPA) & Administrative Services Only (ASO)

SECONDARYHLADABAE

Affordable / Low-Income Assisted Living (Medicaid Waiver Focused)

Healthcare & Life Sciences/Elder Care & Long-Term Care/Assisted Living Facilities

SECONDARYHLADAFAF

Skilled Home Health Aide Services (HHA/CNA under Skilled Plan of Care)

Healthcare & Life Sciences/Elder Care & Long-Term Care/Home Health Care Services (Skilled)

Keywords

• Medicaid managed care
• Community HealthChoices plan
• Long-Term Services and Supports
• Dual-eligible health plan
• Care coordination services

Headquarters

HQ city

Philadelphia

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 Capitation: Capitated payments from the Pennsylvania Department of Human Services (DHS) for providing physical health benefits and long-term services and supports (LTSS) to Community HealthChoices participants. The state contracts with AmeriHealth Caritas PA CHC to manage care for dual-eligible individuals and individuals with physical disabilities.
2. Medicare D-SNP Coordination: Coordination with Medicare D-SNP plans (AmeriHealth Caritas VIP Care) for participants who have both Medicare and Medicaid coverage. Revenue flows through Medicare Advantage plan arrangements for dual-eligible participants.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels8 records

Core offering

AmeriHealth Caritas Pennsylvania Community HealthChoices is a mandatory Medicaid managed care health plan serving dual-eligible individuals and individuals with physical disabilities across Pennsylvania under contract with the PA Department of Human Services. The plan delivers integrated physical health benefits, pharmacy benefits, and long-term services and supports (LTSS), along with care coordination programs such as the Bright Start pregnancy program, tobacco cessation, and Carallel caregiver support. Participants access services through a provider network, a secure participant portal, a mobile app, a 24/7 nurse call line, and dedicated service coordinators.

Product overview

AmeriHealth Caritas Pennsylvania Community HealthChoices is a mandatory Medicaid managed care health plan operating as part of the Pennsylvania Community HealthChoices program. The company serves dual-eligible individuals and individuals with physical disabilities, providing a comprehensive suite of coordinated healthcare services. The core offering consists of medical benefits, pharmacy coverage, and long-term services and supports (LTSS), complemented by specialized care programs including the Bright Start pregnancy program, tobacco cessation support, and Carallel caregiver assistance. Participants access services through multiple channels including a secure Participant Portal, the AHC Mobile App (available on iOS and Android), the HealthSparq provider directory, and pharmacy services through PerformRx and DarwinRx. Healthcare providers interact with the plan via the NaviNet Provider Portal and submit claims electronically through clearinghouses including Availity, Optum/Change Healthcare, and PCH Global. Payment processing is handled through ECHO Health. The company also offers a Medicare D-SNP option called AmeriHealth Caritas VIP Care for participants eligible for both Medicare and Medicaid.

Differentiator

Problem solved

Functional benefit

Brands

• Bright Start: Care management and pregnancy program offered to participants - includes Bright Start for maternity care management and quit smoking programs.

Products and services

• AmeriHealth Caritas PA CHC Health Plan Mandatory Medicaid managed care health plan for dual-eligible individuals and individuals with physical disabilities who qualify for Pennsylvania's Community HealthChoices program, providing physical health benefits and long-term services and supports.
• Long-Term Services and Supports (LTSS)
• Home and Community-Based Services (HCBS) 32 services covering help with activities of daily living provided in participants' homes and communities, designed to help older adults and persons with disabilities live independently.
• Bright Start Program Special pregnancy program designed to help participants have a healthy pregnancy, with dedicated care management support.
• Quit Smoking Program Tobacco cessation program helping participants quit smoking or using other tobacco products through counseling and support services.
• Carallel Caregiver Support Personalized caregiving support services provided at no cost for caregivers of LTSS participants, including coaching, emotional support, and resource coordination.
• Care Coordination Programs Special health programs for participants with specific conditions, providing care management and coordination services tailored to individual health needs.
• AmeriHealth Caritas VIP Care Medicare D-SNP plan for participants who receive both Medicare and Medicaid benefits, designed for people with special needs; coordinates Medicare Advantage coverage with AmeriHealth Caritas PA CHC Medicaid managed care.
• Pharmacy Services and Formulary Pharmacy benefit management including state preferred drug list (PDL), supplemental formulary, specialty pharmacy directory, and pharmacy prior authorization services for plan participants.
• Dental Benefits Dental benefits for participants through dentists in the AmeriHealth Caritas PA CHC network, with some services having limits.
• Vision Benefits Routine eye exams covered for all participants, with eligibility for additional vision services.
• Behavioral Health Services Behavioral health treatment services for participants, with contact information available via PDF for behavioral health providers.

Quantifiable outcome

• Participants receive welcome kit and ID card within 5 days of start date
• +3 more outcomes

Named customers1 record

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration14 records

Feature5 records

Partnerships

Five partnerships are on record, tiered core and minor.

• CarallelcoreStrategic or Co-development PartnerCarallel provides personalized caregiving support services at no cost to family caregivers of AmeriHealth Caritas PA CHC participants receiving LTSS. Services include personalized coaching, emotional support, stress management resources, support groups, and resource coordination. Caregivers can call 1-877-870-5225 or visit app.carallel.com/acpa to sign up.
• PA Enrollment ServicescoreChannel Partner/ Reseller/ DistributorState-contracted enrollment services helping eligible individuals choose a Community HealthChoices health plan. Enrollment specialists help with plan selection, answer questions, and assist with plan changes. Contact: 1-844-824-3655 (TTY 1-833-254-0690) or paieb.com.
• AmeriHealth Caritas VIP CarecoreStrategic or Co-development PartnerMedicare D-SNP plan for participants who have both Medicare and Medicaid coverage. AmeriHealth Caritas VIP Care provides Medicare Advantage coverage coordinated with AmeriHealth Caritas PA CHC Medicaid managed care. Visit www.amerihealthcaritasvipcare.com for more information.
• Pennsylvania Department of Human Services (DHS)coreStrategic or Co-development PartnerPrimary government contract partner for Community HealthChoices managed care program. DHS determines participant eligibility, sets statewide preferred drug list (PDL), and oversees Medical Assistance managed care requirements including LTSS eligibility.
• Language Services Associates (LSA)minorGTM or Marketing PartnerLanguage services provider offering interpreter services for providers at discounted corporate rates. Contact: 1-866-221-1301 for language services including document translation and interpretation support.

Scale indicators3 records

Recent moves6 records

Expansion highlights4 records

Broad incumbents

• Humana Healthy Horizons: Humana Healthy Horizons is Humana's Medicaid managed care arm, with strong overlap in dual-eligible populations through integrated D-SNP and Medicaid MCO strategies across multiple states. Comparable dual-eligible focus with broader Medicare Advantage portfolio.
• Molina Healthcare: Molina Healthcare is a national Medicaid-focused managed care company serving duals and LTSS populations in multiple states, with comparable government-program-only business model and significant scale advantages.
• Highmark Wholecare: Highmark Wholecare (formerly Gateway Health) is a Pennsylvania-focused Medicaid managed care plan with significant dual-eligible and LTSS experience, owned by Highmark Health. Comparable business model in PA Medicaid with broader commercial and Medicare offerings.
• Aetna Better Health (CVS Health): Aetna Better Health operates Medicaid managed care plans across multiple states with growing emphasis on dual-eligible and LTSS populations. Owned by CVS Health, it offers pharmacy and care management capabilities comparable to AmeriHealth Caritas PA CHC.
• Anthem Blue Cross Blue Shield Medicaid: Anthem operates Medicaid managed care plans in multiple states with growing focus on dual-eligible and LTSS populations, including D-SNP products comparable to AmeriHealth Caritas VIP Care. A broad incumbent with significantly larger national scale.
• UnitedHealthcare Community Plan of Pennsylvania: UnitedHealthcare Community Plan operates Medicaid managed care across Pennsylvania and most U.S. states, including dual-eligible and LTSS-adjacent populations. It is a major national Medicaid incumbent with broader product portfolio than AmeriHealth Caritas PA CHC.

Direct peers

• UPMC Health Plan (UPMC Community HealthChoices): UPMC Community HealthChoices is a direct competitor in Pennsylvania's Community HealthChoices program, serving the same dual-eligible and physically disabled LTSS population under a mandatory Medicaid managed care contract awarded by PA DHS.
• AmeriHealth Caritas VIP Care: AmeriHealth Caritas VIP Care is the affiliated Medicare D-SNP that covers the same dual-eligible participants as AmeriHealth Caritas PA CHC, providing the Medicare side of the integrated dual-eligible benefit package.
• Keystone First Community HealthChoices: Keystone First CHC is a sister plan also operating in PA Community HealthChoices, serving the same LTSS/dual-eligible population under a state contract. Highly comparable business model and benefit design within the same mandatory program.
• Pennsylvania Health & Wellness (Centene): Pennsylvania Health & Wellness is another direct competitor in the PA Community HealthChoices program, offering the same statewide physical health + LTSS benefit package to dual-eligibles and physically disabled members under contract with PA DHS.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

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

M&A

Investments1 record

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

Frequently asked questions about AmeriHealth Caritas Pennsylvania Community HealthChoices