What Is Community Health Choices?
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for dually eligible Medical Assistance recipients - 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 was developed to:
Enhance access to and improve coordination of medical care.
Create a person-driven, long-term support system in which people have the choice, control, and access to a full array of quality services that provide independence, health, and quality of life.
To help Long Term Services & Supports (LTSS) eligible individuals perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.
Who Can 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, 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.
An Act 150 participant who is dually eligible for Medicare and Medicaid.
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 and would prefer to participate in a LIFE program and qualifies to participate in LIFE will be free to do so.
What Does CHC Cover?
CHC covers the same physical health benefits that are part of the Medicaid Adult Benefit Package. 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. CHC MCOs have the same responsibility for the coordination of members’ Medicare coverage. Behavioral health services are not a part of CHC. The CHC MCO must coordinate care with their members’ HealthChoices Behavioral Health MCOs.
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