We’re here to help you understand your health care choices. Your questions are important. This is a good place to start if you want to learn about Community HealthChoices (CHC), health plans and PCPs.
If you can't find an answer here, call us at 1-844-824-3655 (TTY 1-833-254-0690).
What is the CHC Program?
Community HealthChoices (CHC) is a new program. CHC uses health plans to coordinate physical health care and long-term services and supports (LTSS). The program is for older persons, persons with physical disabilities, and Pennsylvanians who qualify for both Medicare and Medicaid.
Do I qualify for CHC?
You qualify for CHC if you are age 21 or older and qualify for:
Both Medicare and Medicaid, or
Medicaid long-term services and supports (LTSS) because you need the level of care provided in a nursing facility or through one of the home and community-based waivers
You do not qualify for CHC if you:
Have intellectual or developmental disabilities (ID/DD) and get services through DHS’ Office of Developmental Programs, or
Live in a state-operated nursing facility, including the state veterans’ homes
If you qualify for and choose the Living Independence for the Elderly (LIFE) program, we will not enroll you in CHC unless you ask to be moved to CHC.
How do I apply for CHC?
If you need long-term services and supports (LTSS), contact the Independent Enrollment Broker (IEB) at 1-877-550-4227 (TTY: 1-877-824-9346) or go to www.paieb.com.
If you need physical and behavioral health services, contact your County Assistance Office (CAO). To find the number for the CAO in your county, go to Program resources.
Once the CHC program starts, can I still choose the LIFE program?
Yes. If you are over 55 and require a nursing facility level of care, you may qualify for the LIFE program. In areas where there is a LIFE program, persons who qualify for or who are now in LIFE can choose LIFE instead of CHC. To learn more, go to http://www.dhs.pa.gov/citizens/alternativestonursinghomes/lifelivingindependencefortheelderly.
If I get services through the Department of Aging’s Options Program now, will I still be able to get services through them?
If you qualify for both Medicaid and Medicare but do not qualify for Medicaid LTSS, you can keep getting your long-term services through the Options program. You will get your Medicaid health care services through CHC. You will get your LTSS through Options.
If you clinically qualify later for nursing facility level of care, you can then apply to get your LTSS through CHC.
How do I choose a CHC health plan?
If you qualify for CHC, our enrollment assister will talk to you about your CHC Managed Care Organization (CHC-MCO) choices. The CHC-MCO will be your health plan. Your assister will help you decide which plan best meets your needs. You will choose your CHC plan. The assister will enroll you in CHC. If you do not choose a CHC-MCO, we will automatically assign you to a plan based on your needs.
Or the assister will help you enroll in the LIFE program if you qualify for and want LIFE instead, and it is available in your area.
What services will CHC cover?
CHC covers the same physical health benefits you get now through Medicaid.
If you qualify for Long Term Services and Supports (LTSS), you will keep getting all services offered in the Office of Long-Term Living waivers. You can also get:
How will I get behavioral health services through CHC?
You will get behavioral health services through a HealthChoices behavioral health managed care organization (BH-MCO). CHC-MCOs and BH-MCOs will work together to make sure you get the coordinated services you need. To find the behavioral health plan in your county, go to Program resources.
Will the OLTL waiver programs still be separate waivers?
One CHC waiver will cover all CHC members who qualify for nursing facility level of care. As CHC begins across the state, waiver participants will move to CHC.
The OBRA waiver will continue to serve persons who are age 18 and older and who meet the intermediate care facility and other related conditions level of care.
Will I have to change my provider?
If you live in a nursing facility at the time CHC starts in your county, you can stay in that nursing facility for as long as you stay eligible for CHC.
If you live in the community at the time CHC starts, and choose to stay in the community, the CHC-MCO will support your choice.
You can keep your Medicaid providers for 180 days or until your new service plan starts, whichever comes later. This includes your service coordinators.
After CHC starts, new enrollees and those who change to a different CHC-MCO (health plan) can keep the same services and providers for 60 days from the date of eligibility. During the 60 days, your service coordinator and CHC-MCO will help you choose providers who meet your needs.
How can I stay involved?
You are an important stakeholder in CHC. That means your opinion counts! The Commonwealth of Pennsylvania has a stakeholder engagement process for CHC. Stakeholder input is key to the success of the CHC program. You can get involved in these ways:
CHC Advisory Committee – MLTSS SubMAAC
This committee meets monthly and 50 percent of the members are LTSS participants or caregivers. See the meeting schedule at http://www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/medicalassistanceadvisorycommitteemaac.
Third Thursday webinars
The Department of Human Services (DHS) host public webinars on the third Thursday of every month. You can attend a webinar to get updates and ask questions.
DHS has a email you can use to ask questions or make comments about CHC. The email address is RA-MLTSS@pa.gov.
Webinars on topics of special interest
DHS has webinars on topics of special interest about CHC.
Topic-specific advisory groups
As a need is identified, DHS forms topic-specific advisory groups on technical issues of strong concern to specific groups. More information will be provided when new groups are formed.
CHC-MCO Participant Advisory Committees
Each CHC-MCO must have a Participant Advisory Committee, which welcomes different kinds of people enrolled in the CHC-MCO.
Can I opt out of the CHC Program?
No. You cannot opt out of the CHC Program. CHC is a required program for people who qualify. To learn more, call us at 1-844-824-3655 (TTY 1-833-254-0690).
What is a health plan?
A health plan is a group of doctors, hospitals, clinics and other health care providers. They work together to meet your health care needs.
Can I change my health plan?
Yes. You can change your health plan at any time after you become a CHC member. To learn more, call us at 1-844-824-3655 (TTY 1-833-254-0690).
What is a primary care practitioner (PCP)?
Your PCP is a doctor or other provider who gives you most of your regular health care. This includes checkups and other basic services. Your PCP works closely with you. Your PCP can send you to a specialist or hospital if you need those services.
Can a doctor I see now become my PCP?
Yes, if your doctor works with one of the health plans. To find out which health plans your doctor works with, go to Find a provider.
If you have Medicare and Medicaid, you can keep your Medicare PCP. If your Medicare PCP is not a Medicaid PCP, federal law requires that you will also need to choose a CHC health plan PCP for services that are covered by Medicaid.
Can I get materials in an alternate format?
Yes. You can get materials in an alternate format, such as large print or audio. To ask for materials in another format, call us at 1-844-824-3655 (TTY 1-833-254-0690).