Community HealthChoices Explained

By CAROLINE SMITH

More than 420,000 Pennsylvanians have transitioned into Community HealthChoices. Does this affect you or someone you care for? Chances are it does, and below is a guide on what this means for them.

Community HealthChoices (CHC) has been a hot topic across Pennsylvania for the last three years as a new statewide mandate came out changing the way we provide care and services to those in need, especially the elderly with low incomes, those in long-term nursing facilities, and adults with chronic physical disabilities.

Changes occurred to our statewide Medicaid program, the services that can be received, and how they are being implemented. This new initiative has rolled out across the state of Pennsylvania in three phases beginning in 2018 (southwest), 2019 with the second phase (southeast), and the last phase in January 2020 (middle of the state — this was the largest geographical area).

Community HealthChoices is Pennsylvania’s mandatory managed-care program for adults 21 and older who are eligible for both Medicaid and Medicare, older adults, and those receiving long-term supports and services through physical disability waivers, now known as the CHC waiver.

If someone you care for meets one or more of these qualifications, they have been automatically enrolled in CHC. There are several exceptions — people who will not be enrolled into CHC even if they meet the criteria above.

These exceptions are those in a state-operated hospital, such as a veterans hospital, and those approved for Office of Developmental Program waivers, such as the consolidated waiver or person/family-directed services, LIFE program, and autism waiver, as well as those in the Act150 program or those in the OBRA waiver.

There are three managed care organizations (insurance companies) that are overseeing the state and the services provided under CHC. These insurance companies include PA Health & Wellness (Centene), AmeriHealth Caritas/Keystone First, and UPMC for You.

These insurance companies are responsible to coordinate services and take the confusion out of your care. If someone you care for is enrolled in CHC, they will be asked to choose one of these “plans” or insurance companies.

If they do not choose a plan, a plan will be chosen for them, there to help guide you through these changes and get you what and they will have the opportunity to change plans, if they so you need to be healthy, safe, and independent. choose, as often as once per month. There is no open enrollment For more information on Community HealthChoices, please period and everyone has the opportunity to choose and change contact the UDS Resource Center by calling (888) 837-4235, use their plan at any point. the state number at (844) 824-3655, or visit the CHC website at

Like others in the state, you might be thinking, “Why is www.enrollchc.com. You can also reach out to the managed care this change is happening?” The purpose of CHC is to provide organizations at: better coordination of services to improve the quality of your healthcare experience and to serve more people at home and in • PA Health & Wellness: 844.626.6813 their communities rather than in facilities. Each person enrolled in CHC will be assigned a service coordinator to help them get the • AmeriHealth Caritas/Keystone First: 855.235.4976 services they need. Once they have chosen a managed care organization or insurance company, participants can then request a service coordination agency by simply calling into the insurance company to request United Disabilities Services or any specific agency for service coordination; otherwise, one will be assigned to • UPMC for You: 866.407.8762 Caroline Smith is a program specialist of strategic growth and navigation r you. with United Disabilities Services (UDS), a nationally accredited,

No services that were previously received through the nonprofit organization that provides service coordination among other physical disability waivers or the adult Medicaid package are services. UDS can answer your questions and give you more insight so being reduced. In fact, additional services are being included in you will be able to talk with your care receiver. For more information, CHC that were not available before, such as housing and pest please visit their website at: www.udservices.org. eradication. Medicare is also not affected by CHC at all.

Another change occurring with CHC includes getting another insurance card. It is important to remember not to get rid of Are you a person with a disability or an older adult? any of your existing insurance cards. This YOU HAVE OPTIONS! Community HealthChoices card does not replace another. When you or someone you care for goes to the doctor or the hospital, they should take all of their insurance cards with them and present them to the front desk each time. The PA Link to Aging and Disability Resources is

Important: If you have Medicare and your source for long-term living support services. Medicaid, you will not need to change any medical providers as long as they accept The PA Link can provide person-centered Medicare. Medicare will pick up the first 80% and CHC will pick up the remaining 20% of the bill, no matter which managed counseling to help you access a network care organization you choose or which of private and public your medical providers contract with. community resources

Otherwise, you will want to be sure providing choices to the insurance company you choose is in seniors and those living line with your current waiver and medical providers. with a disability.

Community HealthChoices brings on a lot of changes and new opportunities to those who need assistance to remain independent. Your managed care organization and service coordinator are Call: 1-800-753-8827