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 relatively new program that rolled out in three phases (geographic regions) over a three-year period. The last phase rolled out in January 2020, which means CHC is now available statewide. Individuals who were receiving services via the Pennsylvania Department of Aging Medicaid Waiver were automatically
be enrolled in CHC as it became available in their area.
In order to be eligible for Community HealthChoices, one must be 21 years of age or older and a resident of Pennsylvania. 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 (FBR). As of 2020, this means a single elderly individual cannot have income in excess of $2,349 / 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 the equity value is under $595,000, 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.
A wide variety of services, including long-term care benefits, are covered via this program, and may include the following:
*Please note, eligible applicants who are on Medicare will continue to receive all of the same services as before.
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 enrolling in CHC must choose a Managed Care Organization (MCO), which is how one will receive his or her Medical Assistance (Medicaid) coverage. Current MCO’s include AmeriHealth Caritas Pennsylvania, Pennsylvania Health and Wellness, Keystone First, and UPMC Community HealthChoices. 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.