COMMUNITY HEALTHCHOICES (CHC) is Pennsylvania’s mandatory managed care program for dually eligible individuals and individuals with physical disabilities — serving more people in communities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. CHC will improve services for hundreds of thousands of Pennsylvanians.
CHC has been developed to:
(1) enhance access to and improve coordination of medical care and;
(2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life. Long-term services and supports (LTSS) help eligible individuals to perform daily activities in their home such as bathing, dressing, preparing meals, and administering medications.
Who will enroll in CHC?
Individuals will be enrolled in CHC if they are 21 years old or over and are:
• Receiving both Medicare and Medicaid; or
• Receiving LTSS in the Attendant Care, Independence, COMMCARE, or Aging waivers; or
• Receiving services in the OBRA waiver AND determined nursing facility clinically-eligible; or
• Receiving care in a nursing home paid for by Medicaid; or
• An Act 150 participant who is dually eligible for Medicare and Medicaid.
Individuals CANNOT be enrolled in CHC if they are:
• Receiving LTSS in the OBRA waiver and are not nursing
facility clinically eligible; or
• An Act 150 program participant, who is not dually eligible for Medicare and Medicaid; or
• A person with an intellectual disability or autism who is receiving services beyond supports coordination through the Office of Developmental Programs; or
• A resident in a state-operated nursing facility, including the state veterans’ homes.
Individuals who already participate in a Living Independence for the Elderly (LIFE) program can remain
in their LIFE program and will not be moved into CHC unless they specifically ask to change. Anyone who is enrolled in CHC who would prefer to participate in a LIFE program and qualities to participate in LIFE will be free to do so.
What does CHC cover?
CHC covers the same physical health bene ts that are part of the Medicaid Adult Bene t Package today. If you are eligible for LTSS, you can also get all services now available in waivers offered by the Office of Long-Term Living. With one exception, CHC will replace these waiver programs.
The OBRA waiver will continue to exist for those ages 18-20 years who qualify for Medicaid LTSS, and for those who have a severe developmental physical disability and need an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care.
Behavioral health services are not a part of CHC. The CHC managed care organization (CHC-MCO) must coordinate care for members’ HealthChoices Behavioral Health MCOs. CHC-MCOs have the same responsibility for coordination of members’ Medicare coverage.
Will individuals have a choice of CHC MCOs?
YES. Each CHC participant may choose his or her CHC-MCO. The CHC-MCOs are AmeriHealth Caritas (Keystone First in the Southeast), PA Health & Wellness, and UPMC Community HealthChoices.
For more information for Bucks County residents, call the Bucks County Area Agency on Aging at 267-880-5700 or visit their website.