When it comes to Pennsylvania Community HealthChoices, there’s a lot to know. Whether you’re just learning about the program or are undergoing the assessment process, you’re bound to have questions. In this blog, we’ll answer some of the most frequently asked questions about PA Community HealthChoices to help you get the most out of your coverage.
What is PA Community HealthChoices?
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals with physical disabilities and dually eligible individuals. CHC was developed for two main reasons:
- To enhance access to and improve coordination of medical care for eligible individuals.
- To create a person-driven, long-term support system (LTSS) where people have choice, control, and access to an array of quality services that improve health, quality of life, and independence
LTSS help eligible individuals perform daily activities in their home, such as medication management, preparing meals, dressing, and bathing.
Who is Eligible for CHC?
To be eligible for Community HealthChoices, you must be 21+ and satisfy one of the following:
- Be dually-eligible by receiving Medicare and Medicaid.
- Receive long-term support services (LTSS) via an Attendant Care, Independence, or Aging waiver. These waivers are offered by the PA Office of Long-Term Living. LTSS assists individuals in performing routine daily activities like bathing, dressing, preparing meals, and taking medications.
- Receive services via the OBRA waiver and be determined nursing facility clinically eligible. This waiver covers 18-20 year olds who qualify for Medicaid LTSS and those who have a severe developmental physical disability.
- Receive care in a nursing home paid for by Medicaid.
- Be an Act 150 participant who is dually eligible for Medicare and Medicaid.
- Participate in the Living Independence for the Elderly (LIFE) program. These programs allow people aged 55+ to live independently while receiving services and supports that meet their health and personal needs.
What Are the Benefits of CHC?
There are many benefits of enrolling in PA Community HealthChoices. Physical health MCOs (managed care organizations) offer quality physical care that’s administered on an inpatient or outpatient basis.
When you receive Medicare-covered services, your CHC plan covers any cost sharing, even if the doctor or facility is out of network. You’ll need to use an in-network provider for things that aren’t covered by Medicare (e.g. dentists or optometrists).
You can check out the Adult Benefit Package and Long-Term Services and Supports benefit guide to learn more.
What Are My MCO Options?
CHC MCOs are health insurance plans that cover the physical healthcare and long-term services and supports (LTSS) of enrolled participants. You can choose from the following managed care organizations:
- AmeriHealth Caritas (Keystone First Community HealthChoices in the Southeast)
- PA Health & Wellness
- UPMC Community HealthChoices
CHC breaks the state down into five geographic regions: Southwest, Southeast, Northwest, Northeast, and Lehigh/Capital. All three MCOs are available to you, regardless of which region you live in.