Effective January 1, 2020, big changes are coming the central Pennsylvania Medicaid recipients! The Pennsylvania Department of Human Services (DHS) is preparing to implement the Community HealthChoices (CHC) program in Central (which includes York County), Northeast and Northwest Pennsylvania, and the Lehigh Valley.
CHC is a new Medicaid program that uses managed care insurance companies (MCOs) to take the confusion out of healthcare and see that participants get the medical and social supports they 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 participants get all the benefits and help they need to live the life they 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
The stated purpose of CHC is to enhance care and service coordination, improve health outcomes, and increase availability of community living options for individuals requiring long-term services and supports, so that seniors can have the opportunity to work and spend time with their families, all while having access to long-term services they need.
How will CHC be different from the current Medicaid program? Instead of the Medicaid ACCESS card, Medicaid benefits from the state will come through the CHC health plan that each participant picks. There are 3 to choose from, and you can change your plan at any time:
- AmeriHealth Caritas (known as Keystone First in the Southeast)
- PA Health & Wellness
- UPMC Community HealthChoices
Participants do not need to apply for CHC. It is a mandatory program for people who qualify, so the state DHS will send out information on how to enroll. Pennsylvania’s Independent Enrollment Broker (IEB) can help participants choose or change their plan. They can be reached at 1-844-824-3655 or Enroll CHC.com.
What will be the same? Medicare. If you are covered by Medicare, you can keep your current Medicare plan and doctors. CHC is only about the Medicaid part of benefits. It does not change or replace Medicare coverage. Medicaid, through CHC, is your second insurance and will cover anything that Medicare doesn’t, like long-term care and transportation. It can also help pay your Medicare Part B premium, if your income qualifies. if you are unsure about what Medicare plan you have, you can talk with an APPRISE counselor at your local Office on Aging by calling 1-800-783-7067.
CHC was first launched in southwest Pennsylvania in January 2018 and southeast Pennsylvania in January 2019. When fully implemented across the state, CHC will cover more than 400,000 older Pennsylvanians and adults with physical disabilities, 94 percent of whom are dually eligible for both Medicare and Medicaid.
Ahead of the final implementation, MCOs will host both provider information sessions, and in the fall participant information sessions, which will offer eligible community members the opportunity to learn more about this program and to gather resources and ask questions to choose a plan that will meet their needs.
If you need help with your Medicare planning we can help. The first step is joining us for one of our free “The Nuts & Bolts of Medicaid” workshops. You can RSVP by clicking here now.
Sources: DHS May 13, 2019 Press Release and pahealthaccess.org/chc/