Information in eCIS eligibility records is used to determine which individuals must enroll in Health Choices MCOs. eCIS will display which plan option the individual has. CAO staff cannot enter or change the medical assistance plan option.
Individuals are enrolled in a Community HealthChoices MCO if they are over 21 and are:
All other MA eligible indivdiuals are enrolled in HealthChoices MCO unless they fall under any of the conditions in Section 386.12, Fee-For-Service .
For new recipients, an MCO is assigned after eligibility is determined. The recipient though has the ability to change the plan based on their needs (See Section 386.21 Selecting an MCO).
After an individual has been determined eligible for MA, PA Enrollment Services will reach out to the individual with information about how to select and enroll in an MCO.
Recipients may reach PA Enrollment Services via the following:
PA Enrollment Services will send all of the following to the individual once a plan is selected:
The individual may change their MCO for any reason. Requests for changes are handled by PA Enrollment Services. CAOs should advise individuals to contact PA Enrollment Services at:
An individual will lose MCO coverage if they meet one of the conditions listed in Section 386.12, Fee-For-Service.
Updated August 27, 2025, Replacing March 11, 2013