What is Community HealthChoices?
Community HealthChoices (CHC) is a new Medicaid program that uses managed care insurance companies (MCOs) to take the confusion out of your healthcare and see that you get the medical and social supports you need. The CHC program was created to:
- Make Medicare, Medicaid, Behavioral Health, and Long-Term Services (help at home to live independently) work better together, so you get all the benefits and help you need to live the life you want
- Make it easier for people to live independently, rather than in nursing homes, by improving the quality of in-home support services
- Better address other issues that can keep us from being healthy, like not having a safe place to live, or transportation
when you have both, who covers what?
Medicare is your main insurance and covers:
- Doctor Visits: PCP & Specialists
- Prescription Drugs (Part D Extra Help)
- Hospital Care
- Outpatient Care
- Mental Health (expanded behavioral health benefits are covered by Medicaid, through a Behavioral Health Managed Care plan)
- Labwork & Tests
- Renal Dialysis
- Diabetic supplies
- Durable Medical Equipment (wheelchairs, CPAP, walker, etc)
- Occupational & Physical Therapy
If you are covered by Medicare, you can choose to keep Traditional Medicare, or enroll in a Medicare Advantage (Part C) plan where your benefits come from an insurance company. Medicare Advantage plans for people who qualify for both Medicare and Medicaid are called “Dual Special Needs” plans or D-SNPs and may offer extra benefits like transportation to medical appointments, over-the-counter wellness items, home-delivered meals, and care coordination.
Medicaid is your supplement or second insurance and covers:
- Most co-pays and costs that Medicare doesn’t cover. Depending on your income, Medicaid may also pay for your Part B premium.
- Dental & Vision
- Transportation to Medical Appointments through Pennsylvania’s Medical Assistance Transportation Program (MATP)
- Other services that Medicare won’t fully cover or authorize
Long-Term Services & Supports (help in your home to live independently that is available if you are assessed by the Office on Aging and your primary care doctor as needing help with everyday tasks like bathing, dressing, making meals, climbing stairs, and managing finances or medications):
- Personal Care (a direct care worker or attendant that you can hire directly, or get through a home care agency)
- Home Modifications like a ramp, stairlift, or handrails to make your living environment safe and accessible
- Nursing Home Transition (moving back home or to an apartment)
- Non-Medical Transportation (to attend religious services, go to the grocery store, visit family, or other activities important to you)
Your Community HealthChoices plan will help Medicare and Medicaid work better together and coordinate care with your behavioral health plan.
HOME & COMMUNITY-BASED “WAIVER” SERVICES UNDER CHC
If you are currently getting in-home services and support through an Office of Long-Term Living Medicaid “waiver” program:
- You’ll continue to receive those same services under Community HealthChoices
- Your new CHC health plan must work with all of your current long-term care providers (through June 30th)
- Your current Service Plan that outlines what kind of in-home care & support you get cannot be reduced (through June 30th)
- AFTER June 30th, you’ll need to use long-term care providers that are part of your CHC plan’s network
- AFTER June 30th, your CHC plan will work with you, your family or caregivers, your Service Coordinator, and your doctors to make sure your Person-Centered Service Plan (which outlines what kind of help you get, how often, based on your goals) reflects your needs, values, and priorities
- Pennsylvania’s Independent Enrollment Broker (1-844-824-3655), or your CHC plan, can tell you which providers are in your plan’s network — just call them and ask!
What kinds of long-term services and supports are covered?
- A personal care attendant to help with bathing, dressing, making meals, light housekeeping, and other everyday needs
- Equipment and modifications to your home or car to make them safe for you, like hand controls in the car or a stairlift
- Help keeping your home environment clean, including from bugs and mold
- Transportation for both medical and social needs (getting to the doctor, the grocery store, religious services, a job or volunteer activity etc.)
- Home-delivered meals and help building healthy, nutritious eating habits
- Help finding employment and safe, stable housing
- Service coordination, to arrange for all the long-term services you need
If you are not currently receiving long-term services and support, your CHC plan can help you apply. It’s their job to keep you healthy and safe at home!
- Learn more: https://pahealthaccess.org/chc/