What is Community Health Choices (CHC)?
Community Health Choices (CHC) is a model in which Managed Care Organizations deliver and pay for your services instead of the state.
Essentially, that means that the state uses insurance companies to pay for health services instead of paying directly for your care, which saves the state money over time.
Without CHC, we provide you with care, and we bill the state for those services. But with CHC, our services are billed to your Managed Care Organization instead.
CHC will coordinate your healthcare services and coverage to improve the quality of your healthcare experience, which means serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
Community Health Choices (CHC) is a model in which Managed Care Organizations deliver and pay for your services instead of the state.
Essentially, that means that the state uses insurance companies to pay for health services instead of paying directly for your care, which saves the state money over time.
Without CHC, we provide you with care, and we bill the state for those services. But with CHC, our services are billed to your Managed Care Organization instead.
CHC will coordinate your healthcare services and coverage to improve the quality of your healthcare experience, which means serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
What is CHC?
- I still don’t understand what that means.
- Right now, we provide you with care and we bill the state for those services. Starting next year, we will bill your “Managed Care Organization” (MCO) instead of the state.
- What is managed care?
- NOTE: (IN THIS CONTEXT) Managed Care is when an insurance company gets money from the state to pay for healthcare services.
- Why are they doing this now?
- State’s do this because it is cheaper for the state to have insurance companies pay for services instead of doing it themselves.
- NOTE: Managed Care exists for other sorts of Medicaid programs in Pennsylvania already, it is long term care that is just now shifting over to a managed care model. Depending on the patient’s eligibility status and how they pay for their care, they may already be working with a Medicaid managed care network.
What Is a Managed Care Organization?
Understanding how the Community Health Choices model functions is important, and you can’t completely grasp the program unless you also comprehend managed care organizations.
An MCO is a health plan or healthcare company that ensures high-quality care while limiting costs. By using an MCO, the price of your at-home care through AmeriBest or a variety of other home care agencies will cost the state less over time than using the services without it.
Essentially, Managed Care Organizations work with Medicaid, your home care company, and the state. And once you’ve signed up for CHC through MCO, they will take care of the rest!
There are four types of MCO or plans that you should be aware of:
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- Point Of Service (POS)
- Exclusive Provider Organization (EPO)
But don’t worry; you don’t have to select the right program for yourself or your loved ones; here at AmeriBest, we can do that for you.
MCOs in Philadelphia have become extremely popular in various other Medicaid programs, but now, the MCO program can be utilized for at-home care through Community Health Choices.
What Is Community Health Choices in PA?
Now that you understand in theory what CHC and MCO are, you certainly need to know what they can mean for you and your loved ones here in Pennsylvania.
Here are a few important facts about Community Health Choices in PA you need to understand:
- If you did not select a personalized CHC plan before December 20th, 2019, a plan will be assigned to you upon application.
- You will still be able to receive personal care services from your aid when your CHC starts.
- Your personalized care hours and schedule will not change once CHC goes into effect.
- Caregivers will still be paid by AmeriBest, just as they are now, even after CHC begins.
- After about 6 months, MCOs will eventually take steps to make care more efficient and less costly, although how this affects a given client can vary.
- You are still entitled to the same coverage you have before CHC starts.
- If you have an issue with your Medicaid or insurance when applying to an MCO, AmeriBest can act as your advocate to assist you.
Now, let’s find out if you are eligible for Community Health Choices in PA.
Who Is Eligible for Community Health Choices?
According to the Pennsylvania Department of Human Services (DHS):
“If you’re 21 or older and have both Medicare and Medicaid or receive long-term support through Medicaid because you need help with everyday personal tasks, you will be covered by Community HealthChoices (CHC).”
In fact, all individuals be enrolled in CHC if they are 21 years old or over and fall into the following categories:
- Receive both Medicare and Medicaid.
- Receive long-term services and supports, such as Attendant Care, Independence, COMMCARE, or Aging waivers.
- Receive services in the OBRA waiver and are eligible for nursing facilities.
- Receive care in a nursing home paid for by Medicaid
- Act 150 participants are dually eligible for Medicare and Medicaid.
It’s important to understand that when it comes to Community Health Choices, Medicaid is a requirement. So if you have not yet applied for Medicaid, that is the first step toward becoming eligible for the program.
If you have more questions as to your or your loved one’s eligibility, you can call the Pennsylvania DHS Community Health Choices program directly toll-free at 1-844-824-3655 (TTY 711.)
Do I have to choose a CHC plan?
You can no longer choose. The deadline for selecting a CHC Plan of your choice was on December 20th, 2019.
If you did not select a plan by this date, a CHC Plan will be assigned to you.
Can I still stay with AmeriBest?
Yes, you will be able to stay with us as your Home Care provider if you would like.
What is this going to do to my…(hours, aide, care, etc.)
Aide: You will still be able to receive personal care services from your aide when CHC starts next year.
Hours: Your hours will not change when CHC goes into effect January 2019.
Care: Your care plan should not change when CHC goes in effect January 2019.
(For Caregivers) Pay: You will still be paid by AmeriBest as you are now, CHC will not change how caregivers are paid.
NOTE:
Things should not change substantially for consumers for ~6 months following CHC implementation; the MCOs will eventually take steps to make care more efficient and less costly although how this affect a given client can vary.
It says my mental/behavioral health isn’t covered!
- You are still entitled to the same coverage you have before CHC starts. The notice is just telling you that the long-term care program isn’t paying for those services, another “part” of your state benefits covers that, and depending on your waiver program, that “part” might be one of the new MCOs.
- NOTE: Aging waiver participants will be moved from ACCESS to a behavioral health MCO, other participants should not be affected as they should already have their mental health coverage provided through an MCO.
- If you have an issue with your insurance, AmeriBest can act as your advocate with the insurance company to assist you.
- NOTE: The MCOs have a grievance and fair process that participants can use to dispute a reduction or change in services. AmeriBest can be authorized by the participant to represent that patient’s interests.
Community Health Choices Waiver
- When reading about the CHC program as well as the MCO options, you will often see “Community Health Choices Waiver.” So what is the CHC Waiver?
- It’s actually just the term given to the CHC approval, meaning that by working within the new CHC guidelines, you have received a Community Health Choices Waiver.
- Therefore, the Community Health Choices Waiver Program is the exact same as the CHC program.
Benefits of MCO Plans
Finally, each CHC or CHC Waiver participant has the opportunity to choose their Managed Care Organization (MCO.)
The MCO you select will not only work with the state and your home-care provider to ensure the best possible and most affordable care is organized, but each of the organizations also offers additional and sometimes different benefits.
CHC/MCO Quick Responses / Fact Sheet
- I still don’t understand what that means.
- Right now, we provide you with care and we bill the state for those services. Starting next year, we will bill your “Managed Care Organization” (MCO) instead of the state.
- What is managed care?
- NOTE: (IN THIS CONTEXT) Managed Care is when an insurance company gets money from the state to pay for healthcare services.
- Why are they doing this now?
- State’s do this because it is cheaper for the state to have insurance companies pay for services instead of doing it themselves.
- NOTE: Managed Care exists for other sorts of Medicaid programs in Pennsylvania already, it is long term care that is just now shifting over to a managed care model. Depending on the patient’s eligibility status and how they pay for their care, they may already be working with a Medicaid managed care network.
Yes, you will be able to stay with us as your Home Care provider if you would like.
- Aide: You will still be able to receive personal care services from your aide when CHC starts next year.
- Hours: Your hours will not change when CHC goes into effect January 2019.
- Care: Your care plan should not change when CHC goes in effect January 2019.
- (For Caregivers) Pay: You will still be paid by AmeriBest as you are now, CHC will not change how caregivers are paid.
- NOTE:
- Things should not change substantially for consumers for ~6 months following CHC implementation; the MCOs will eventually take steps to make care more efficient and less costly although how this affect a given client can vary.
- You are still entitled to the same coverage you have before CHC starts. The notice is just telling you that the long-term care program isn’t paying for those services, another “part” of your state benefits covers that, and depending on your waiver program, that “part” might be one of the new MCOs.
- NOTE: Aging waiver participants will be moved from ACCESS to a behavioral health MCO, other participants should not be affected as they should already have their mental health coverage provided through an MCO.
- If you have an issue with your insurance, AmeriBest can act as your advocate with the insurance company to assist you.
- NOTE: The MCOs have a grievance and fair process that participants can use to dispute a reduction or change in services. AmeriBest can be authorized by the participant to represent that patient’s interests.
Comparative Benefits of the CHC MCO Plans
Added benefits. The added benefits listed below are in addition to benefits already covered by Medicaid and/or Medicare.
Adult dental
- Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit.
Adult vision
- Beyond Medicaid covered vision services, no extra services.
Phone services
- Free Smartphone with 350 minutes of talk and unlimited text
Wellness programs
- Home provider visits, lab draws and testing for qualified participants
- Video visits with care manager
- Bright Start maternity program
- Box fan qualified participants
- Health and wellness gift cards
Other benefits
- In-home supports and services to help participants not approved for LTSS avoid nursing home stay
- Welcome Home Benefit helps qualified participants with LTSS move from nursing facility to home, with up to $6,000 for rental assistance ($2,000 more than the $4,000 stat limit.)
- For those not approved for LTSS, caregiver programs offer education, respite services and supports
Adult dental
- Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit.
Adult vision
- Beyond Medicaid covered vision services, no extra services.
Phone services
- Free Smartphone with 350 minutes of talk and unlimited text
Wellness programs
- Home provider visits, lab draws and testing for qualified participants
- Video visits with care manager
- Bright Start maternity program
- Box fan qualified participants
- Health and wellness gift cards
Other benefits
- In-home supports and services to help participants not approved for LTSS avoid nursing home stay
- Welcome Home Benefit helps qualified participants with LTSS move from nursing facility to home, with up to $6,000 for rental assistance ($2,000 more than the $4,000 stat limit.)
- For those not approved for LTSS, caregiver programs offer education, respite services and supports
Adult dental
- Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit.
Adult vision
- Beyond Medicaid covered vision services, no extra services.
Phone services
- Free Smartphone with 350 minutes of talk and unlimited text
Wellness programs
- Home provider visits, lab draws and testing for qualified participants
- Video visits with care manager
- Bright Start maternity program
- Box fan qualified participants
- Health and wellness gift cards
Other benefits
- In-home supports and services to help participants not approved for LTSS avoid nursing home stay
- Welcome Home Benefit helps qualified participants with LTSS move from nursing facility to home, with up to $6,000 for rental assistance ($2,000 more than the $4,000 stat limit.)
- For those not approved for LTSS, caregiver programs offer education, respite services and supports