What You Need to Know About Community Health Choices

Written by Marx Medical Equipment | 2/20/19 1:02 PM

Visitors to our website know that Marx Medical offers supplies and home modifications that are covered by Pennsylvania’s Community Health Choices program.

But what is Community Health Choices? What does it entail and who does it cover?

We’re committed to making life simpler for our customers, so we put together this blog post to answer those questions. Read on to learn more about Community Health Choices.

What is Community Health Choices?

Community Health Choices (or CHC) is the state’s mandatory managed care program for dually eligible individuals and people with disabilities.

According to the Pennsylvania Department of Human Services, the program’s goal is to serve hundreds of thousands more Pennsylvanians “giving them the opportunity to work, spend more time with their families and experience an overall better quality of life.”

It was developed to:

Improve access to and coordination of medical care
Create a “person-driven, long-term support system” that gives people choice, control and access to quality services for better health, independence and quality of life.

Who can enroll in CHC?

People will be enrolled in Community Health Choices if they are 21 or over and:

Receive both Medicare and Medicaid, OR
Receive long term services and supports (LTSS) in the attendant care, independence or aging waivers PR
Receive service in the OBRA and is clinically eligible for a nursing facility
Receive nursing home care paid for by Medicaid
Are an Act 150 participant dually eligible for Medicare and Medicaid

Who can’t enroll in CHC?

People are not eligible for Community Health Choices if they are:

Receiving LTSS in the OBRA waiver and are not clinically eligible for a nursing facility
An Act 150 participant that is NOT dually eligible for Medicare and Medicaid
Someone with an intellectual or developmental disability who gets services through the Department of Human Services Office of Developmental Programs
A resident of a state-run nursing facility (this includes state veterans’ homes)

According to the Department of Human Services, people already involved in a Living Independence for the Elderly (LIFE) program can remain in the program and will not be moved to CHC unless they ask for that change.

People enrolled in Community Health Choices who would rather be involved in LIFE can do so assuming they qualify.

What does Community Health Choices cover?

CHC covers the same physical health benefits once covered by the Medicaid Adult Benefit Package. If you are LTSS eligible, you can also get all the services available with waivers from the Office of Long-Term Living.

OBRA waivers will continue for people between 18 and 20 who qualify for Medicaid LTSS as well as those with severe physical disabilities who need an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care.

Community Health Choices does not include behavioral health services. Your CHC managed care organization (MCO) must coordinate care with your Health Choices behavioral health MCO. These MCOs have the same responsibility for coordinating member’s coverage under Medicare.

Can I choose my MCO?

Yes. Everyone who participates in CHC can pick from one of three MCOs: AmeriHealth Caritas, PA Health & Wellness and UPMC Community HealthChoices.

When will CHC begin in my community?

Community Health Choices began operating in southwestern Pennsylvania in January of 2018. It took effect in January of this year in Pennsylvania’s southeast region, which includes Philadelphia along with Bucks, Chester, Delaware and Montgomery counties.

In January of 2020, it will be phased in across the rest of the state.

While managed care may be changing in Pennsylvania, one thing remains the same here at Marx Medical, desire to make sure our customers live in safe, accessible homes, whether that means adding stair lifts and elevators, ramps and railings or bathroom modifications. We are in-network for all three managed care organizations in Pennsylvania: UPMC, Keystone First and PA Health & Wellness.

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