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Community HealthChoices: Changes Coming to Those Who Have Both Medicare AND Medicaid!

On Behalf of | Aug 19, 2019 | Elder Law

Community HealthChoices (CHC) is Pennsylvania’s new Medicaid program that uses managed care insurance companies (MCOs) for most people who have both Medicare and Medicaid due to their age, income, or disability; people whose nursing home stay is covered by Medicaid; and people who receive home and community-based “waiver” services.

The goal of CHC is to improve the health, safety, and wellness of Pennsylvanians by combining health care, long-term care services and supports, and behavioral health through a managed care plan that provides you the benefits and help you need to live the life you want. CHC is intended to make it easier for people to live independently by improving the quality of in-home support services.

CHC has already been implemented in the Philadelphia and Pittsburgh areas and will be implemented in Northeastern and Central Pennsylvania on January 1, 2020. People who are going to be transitioned to CHC will be notified at least 90 days before implementation. Some people are already receiving written notice of the change with the option to choose which MCO plan they want to enroll in.

How does this affect your Medicare?

CHC does NOT change or replace your Medicare coverage. CHC only changes the Medicaid portion of benefits for the individuals receiving such coverage.

How does CHC affect your Medicaid?

If you have an ACCESS card, your Medicaid benefits will now come through the CHC health plan that you choose. There are three CHC health plans to choose from: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices. Because CHC is mandatory for people who qualify, the Department of Human Services will send you information on how to enroll.

Service providers such as physicians, hospitals, nursing facilities, home health care providers, etc., do not need to contract with all three MCOs. Therefore, it is our advice to be proactive in asking which MCO your service provider has contracted with so that you can choose the MCO that best fits your care needs.

Attorney Marissa Marshall is a Certified Elder Law Attorney at Kreisher Marshall & Associates, LLC, Bloomsburg. Attorney Marshall specializes in Medicaid and Asset Protection Planning and provides home, hospital or nursing facility visits. She can be reached at (570) 784-5211 ext 2.