Pennsylvania Medicaid’s Community HealthChoices Program  

Program Description

The Pennsylvania Community HealthChoices (CHC) Program is a Medicaid managed care program for persons who are 21 years of age or older and are eligible for both Medicaid (known as Medicaid Assistance in Pennsylvania) and Medicare (the federal health insurance program) or those who require a nursing home level of care. While this program is not strictly for the elderly, it is very relevant for seniors, as many are dually eligible for Medicaid and Medicare and / or require a level of care consistent to that provided by a nursing home.

CHC provides seniors and physically disabled individuals with medical benefits, as well as long-term support services to promote independent living and prevent unnecessary nursing home placements. Benefits include personal care services, such as assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADL), like bathing, meal preparation, and medication management. Enrollment in this program is mandatory for those who meet the eligibility requirements.

CHC is a new program that will roll out in phases (geographic regions) over a two-year period, beginning in January 2018. Individuals who are currently receiving services via the Pennsylvania Department of Aging Medicaid Waiver will automatically be enrolled in CHC as it becomes available in their area.

 

Eligibility Guidelines

In order to be eligible for Community HealthChoices, one must be 21 years of age or older, a resident of Pennsylvania, and live in a region of the state that is currently offering the program. CHC will roll out in three phases and is as follows:

  • As of January 1, 2018, CHC will be available in the Southwest region of the state. This includes the following counties: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene Indiana, Lawrence, Somerset, Washington, and Westmoreland.
  • In January 2018, the second phase will roll out, which will be the Southeast Region. The counties in this area are as follows: Bucks, Chester, Delaware, Montgomery, and Philadelphia.
  • In January 2020, the final phase will begin for the remainder of the regions, which include the counties in Lehigh/Capital, Northwest, and Northeast.

Applicants must also require a nursing home level of care or be eligible for both Medicaid and Medicare. In order to be eligible for Medicaid, there are both income and asset limits. For the state of Pennsylvania, as a general rule of thumb, seniors must have income no greater than 300% of the Federal Benefit Rate. As of 2018, this means a single elderly individual cannot have income in excess of $2,250 / month. The asset limit for a single senior is $2,000, although the state of Pennsylvania allows an additional $6,000 to be disregarded, allowing a total disregard of $8,000. In addition, certain exemptions are allowed, such as one’s home, given the individual lives in the home, or intends to return to the home, and it is valued under $572,000, household items, and personal effects.

To be eligible for Long-Term Services and Supports (LTSS), an individual must require a level of care consistent with a nursing home.

 Individuals enrolled in the Pennsylvania Department of Aging Medicaid Waiver, as well as those who are receiving Medicaid-funded nursing home care, will automatically be enrolled in CHC as the program becomes available in their area.

 

Benefits and Services

A wide variety of services, including long-term care services, are covered via this program, and may include the following:

  • Adult Daily Living Services / Adult Day Health
  • Assistive Technology / Durable Medical Equipment
  • Medical Supplies
  • Home Health Aid / Nursing 
  • Meal Delivery / Nutritional Supplements
  • Respite Care
  • Non-Medical Transportation
  • Personal Emergency Response Systems
  • Home / Vehicle Modifications
  • Nursing Home Care
  • Hospice Care
  • Medical / Dental Services
  • Emergency Room Services
  • Prescription Drugs
  • Personal Assistance Services 
  • Counseling
  • Service Coordination
  • TeleCare
  • Consumer Direction of Goods / Services (available via Services My Way)

*Please note, eligible applicants who are on Medicare will continue to receive all of the same services as before.

 

How to Apply / Learn More

For more information about CHC, click here.

Persons who are not yet approved for PA Medicaid, should determine if they are eligible. If not eligible, they might consider working with a Medicaid planner professional. If they are eligible, they should contact their local County Assistance Office

Individuals who have mandatory enrollment will be advised no fewer than 90 days prior to the implementation of Community HealthChoices in the region in which they live. Those who are being enrolled in CHC must choose a Managed Care Organization (MCO), which is how one will receive their Medical Assistance (Medicaid) coverage. Current MCO’s include AmeriHealth Caritas Pennsylvania, Pennsylvania Health and Wellness (Centene), and UPMC for You. To choose your plan, call 844-824-3655 or do it online here. If you do not choose a plan, you will automatically be enrolled in one.