Community HealthChoices 101

Community HealthChoices 101

What is Community HealthChoices?

Community HealthChoices (CHC) is a new Medicaid managed care program for certain people currently on Medicaid. Department of Human Services and the office of Long Term Living will pay CHC plans and monitor them. The goal is to deliver and pay for Medicaid physical health and long-term service and supports (LTSS) coverage where eligible. CHC plans will be responsible for developing provider networks, approving services and paying providers.

This means that beneficiaries will not use their access card. They will show their CHC plan ID card that covers the same as Medicaid and more. The project rollout in Pennsylvania began in January 2018 and will continue into 2020.

Long-term services and supports (LTSS) coverage is a new term that includes the various services people currently get at home through waiver programs or in a nursing home. Not all individuals moved to CHC will get LTSS benefits, as they will need to be clinically eligible.

Who is eligible?

Adults 21 and older who:

  • Dual-eligible, Medicare and Medicaid (with some exceptions)
  • Currently receiving LTSS through the Aging waiver, Attendant Care, Independence, CommCare
  • Currently receiving LTSS through the OBRA waiver unless they were not determined nursing facility clinically eligible (NFCE)
  • Currently in a nursing home paid for by Medicaid

The state chose 3 plans to deliver services under CHC:

  • AmeriHealth Caritas
  • PA Health & Wellness (Centene)
  • UPMC Community HealthChoices

How does a beneficiary enroll?

If eligible to receive CHC benefits, the beneficiary will receive an invitation to a CHC educational meeting. The beneficiary will be given the opportunity to choose a plan before being auto-enrolled for 2020. An agent can help guide them while choosing a plan, URL has contracting available for all 3 carriers. Just complete our quick and easy FLASH packet.

What does this mean for the Special Needs Carrier Plans that were not chosen or not participating?

There is no rule that states an individual on the CHC coverage through the Medicaid portion must get rid of their current DSNP or MAPD they have through other carriers. For example, they may have CHC through PA Health & Wellness (Centene) and have a DSNP through a non-participating carrier. The non-participating provider would be primary and CHC would pick up the balance, so there would be a coordination of benefits.

Choosing a sponsor plan for CHC benefits does not affect your DSNP or MAPD enrollment. A member can change their CHC benefit plan once a month. An agent can enroll a beneficiary into a participating or non-participating D-SNP or MAPD during the AEP, OEP, and/or SEP. If consumers are happy with Original Medicare or their Medicare plan, they are free to stick with what is working for them.

What isn't affected by these changes?

  • Medicare coverage
  • Medicaid eligibility
  • LIFE Program
  • Autism Waivers
  • OPTIONS/ACT 150

Important contact information

Maximus Independent Enrollment Broker:

Consumers should call Maximus if:

  • They do not know what plan they are enrolled in
  • Their selected plan is not the plan they got put in
  • They want help figuring out which plan covers their medical providers
  • They want to change their plan
  • They want to apply for LTSS either at home or in a nursing home

How you can help

Now that you are informed, here are my personal and professional thoughts. Anything new causes chaos. Be a resource for your clients and the calm during the storm. CHC had a bumpy road rolling this out in other areas. Let's make Central PA easier, not harder.

At the end of the day, it's a beautiful idea to help improve the quality of care while giving older Pennsylvanians and disabled individuals more opportunity to work, spend time with their families, and experience an overall better quality of life. Most of us are in this line of business to do just that- help people!

The benefit of enrolling a beneficiary into a D-SNP or MAPD matching the CHC plan is to maximize care management and coordination of benefits. The best comparison I could think of was PACE/PACENET. If you have an individual that is eligible for PACE, would you enroll them with a carrier that doesn't participate with those added benefits/savings? You can, but should you?

Learn more

We've included some videos and downloads below so you can educate yourself further, and you can look forward to us touching on this topic during our 2020 Medicare Connections Conference on September 4th at the Hershey Lodge.



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Saturday, 24 July 2021

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