Managed Care Resource Center
Beginning January 2019
Community Health Choices (CHC), Pennsylvania’s managed care program is coming to Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.
If you currently use home and community-based services (HCBS) under one of the Medicaid Waivers (Aging Waiver, Attendant Care Waiver, Independence Waiver, OBRA Waiver) or an individual who is dually eligible for Medicare and Medicaid, it is important for you to know that important changes are coming.
The Pennsylvania Department of Human Services will be replacing these existing waivers with one program called Community Health Choices (CHC).
Community Health Choices (CHC) is a Medicaid managed care program. This means you will choose a health plan to manage all of your physical health care and long-term services and supports (LTSS).
CHC WILL NOT CHANGE YOUR MEDICARE BENEFITS
There are three managed care health plans to choose from:
- Keystone First Community HealthChoices
- PA Health & Wellness
- UPMC Community HealthChoices
If you qualify for CHC, you will receive more information in August of 2018 to help you pick a plan.
You will be enrolled into CHC if you are age 21 or older and
- Get both Medicare and Medicaid, OR
- Get LTSS in the Attendant Care, Independence, or Aging waivers, OR
- Get LTSS in the OBRA waiver and qualify clinically for a nursing facility, OR
- Get care in a nursing home paid for by Medicaid
You do not qualify for CHC if you
- Get LTSS in the OBRA waiver and do not qualify clinically for a nursing facility level of care;OR
- Have an intellectual or developmental disability and get services through the Department of Human Services Office of Developmental Programs, OR
- Live in a state-operated nursing facility, including the state veterans’ homes
If you qualify for CHC and don’t choose one of the three managed care health plans in your region by the enrolment deadline you will be automatically assigned to one.
For more information, visit http://www.healthchoices.pa.gov or call the CHC consumer hotline at 1-833-735-4416
Person Centered Service Planning and Appeals
The Pennsylvania Health Law Project has created the My Person-Centered Service Plan WORKSHEET to help you think about your plan for your life, personal and professional connections, and your goals and dreams and how to reach them!
It can be very helpful to review and complete all parts of this Worksheet that you can before you meet with your Service Coordinator and the rest of your Team. You can the My Person-Centered Service Plan WORKSHEET here: www.phlp.org/wp-content/uploads/2018/10/PCSP-Consumer-materials.pdf
The Pennsylvania Health Law Project has also created a two part video series to help explain how services are identified and approved as well as the appeals process under Community Health Choices.
The first Video covers the Person Centered Planning, which can be viewed here: https://www.youtube.com/watch?v=v-IB58MSlmI
The second video covers the appeals process, which can be viewed here: https://www.youtube.com/watch?v=DoshX2vVnGs
For more Information on Community Health Choices, visit http://www.healthchoices.pa.gov/info/about/community/index.html
For Frequently asked questions, visit http://www.healthchoices.pa.gov/providers/about/community/participantfaqs/index.html
For enrollment and provider information ,visit http://www.enrollchc.com/home
For the differences between Medicare and Medicaid, visit https://libertyresources.org/differences-between-medicare-and-medicaid/
For more information on Community Health Choices and Medicare, visit https://libertyresources.org/will-chc-affect-my-medicare/
To view and track the progress of Community Health Choices, visit http://www.nasuad.org/initiatives/tracking-state-activity/state-medicaid-integration-tracker/pennsylvania
To view the Center for Advocacy for the Rights and Interests of the Elderly (CARIE) advocacy guide on Community Health Choices, visit https://www.carie.org/news-event/carie-chc-advocates-guide/