What is Community HealthChoices?

Community HealthChoices (CHC) is a new Medicaid program that uses managed care insurance companies (MCOs) to keep you healthy and happy at home by:

  • Making sure you get high-quality healthcare
  • Keeping your home environment safe
  • Helping you get home-based long-term services
  • Connecting you with other resources, like housing and transportation

What will be different in CHC?

Instead of the ACCESS card, Medicaid benefits will come through the MCO that you pick. There are 3 to choose from:

  • AmeriHealth Caritas
  • PA Health & Wellness
  • UPMC Community HealthChoices

You may change your plan at any time! Call PA’s Independent Enrollment Broker: 1-844-824-3655 or go to: EnrollCHC.com

What will be the same?

Medicare! CHC is only about the Medicaid part of your benefits. This means you can keep your current Medicare plan and doctors. Medicaid, through CHC, will cover anything that Medicare doesn’t, like long-term care and transportation.

Who will be covered by CHC?

Most people who have both MEDICARE & MEDICAID due to their age, income, or disability.

Community HealthChoices does NOT change Medicare &

Instead of the ACCESS Card, Your Medicaid Benefits Will Come Through a Community HealthChoices MCOAlso:

  • People who receive home and community-based services for help with daily needs like bathing and meals
  • People whose stay in a nursing home is covered by Medicaid

Not sure if you qualify? We can help! Call Erin: 1-844-474-2643.

WHEN YOU HAVE BOTH, WHO COVERS WHAT?

Medicare

is your primary insurance and covers:

  • Doctor Visits: PCP & Specialists
  • Prescription Drugs (Part D Extra Help)
  • Hospital Care
  • Outpatient Care
  • Mental Health
  • Labwork & Tests
  • Renal Dialysis
  • Diabetic supplies
  • Durable Medical Equipment (wheelchairs, CPAP, walker, etc)
  • Occupational & Physical Therapy

Medicaid

is your supplement and covers:

  • Any costs or co-pays Medicare doesn’t cover
  • Dental & Vision
  • Chiropractor
  • Podiatrist
  • Transportation to Medical Appointments
  • Any services that Medicare won’t fully cover or authorize
  • Long-Term Services & Supports (if you qualify, based on need)
  • Personal Care Aide
  • Home Modifications
  • Nursing Home Transition (moving back home or to an apartment)

Your Community HealthChoices plan will help Medicare and Medicaid work better together and coordinate care with your behavioral health plan.

HOME & COMMUNITY-BASED 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 MCO must work with all of your current long-term care providers (through June 30, 2018)
  • Your current Service Plan that outlines what kind of in-home care & support you get cannot be reduced (through June 30, 2018)
  • AFTER June 30, 2018, you’ll need to use long-term care providers that are part of your MCOs network
  • AFTER June 30, 2018, or whenever you request it, your MCO will work with you, your family or caregivers, your Service Coordinator, and your doctors to make sure your Person-Centered Service Plan reflects your needs, values, and priorities
  • The Independent Enrollment Broker (1-844-824-3655), or your MCO, can tell you which providers are in your MCOs network — just call them and ask!

What kinds of long-term services and supports are covered?

Community HealthChoices Covers Long-Term Services at Home!

  • A personal care attendant to help with bathing, dressing and everyday needs
  • Equipment and modifications to your home or car to make them safe for you
  • Help keeping your home environment clean, including from pests and mold
  • Transportation for both medical and social needs (getting to the doctor, the grocery store, church, 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 MCO can help you apply. It’s their job to keep you healthy and safe at home!

PHAN is Here to Help You Understand Community HealthChoices!

WE WANT TO HEAR FROM YOU!

As advocates, we’re working to make sure Community HealthChoices and the three managed care companies are doing right by you!

Learning about your experiences and everyday needs helps us do that. Sharing your story is powerful in creating change!

TELL US WHAT YOU NEED TO LIVE WELL!

If you run into problems getting care or services, have questions, or want to join our advocacy efforts, contact PHAN’s Consumer Engagement Manager Erin Ninehouser at: (412) 863-1047 or erin@pahealthaccess.org.

Learn more about Community HealthChoices: