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Community HealthChoices

Community HealthChoices (CHC) is a Medicaid initiative that streamlines healthcare and supports individuals with medical and social needs. It utilizes managed care insurance companies (MCOs) to simplify healthcare delivery. The program’s main objectives are:

  1. Coordinate healthcare services: CHC enhances collaboration among Medicare, Medicaid, Behavioral Health, and Long-Term Services to optimize benefits and assistance for individuals, ensuring comprehensive support.

  2. Promote independent living: By improving the quality of in-home support services, CHC enables individuals to live independently, reducing reliance on nursing homes.

  3. Address health-related challenges: CHC tackles barriers to well-being, such as unsafe housing and transportation issues, by providing comprehensive solutions beyond medical care, improving overall health outcomes and community wellness.

In summary, Community HealthChoices (CHC) integrates Medicare, Medicaid, Behavioral Health, and Long-Term Services while enhancing in-home support. It also addresses health-related barriers to ensure individuals receive holistic care.

Medicare and Medicaid, who covers what

Medicare is your main insurance and covers:

  • Doctor Visits: PCP & Specialists
  • Prescription Drugs (Part D Extra Help)
  • Hospital Care
  • Outpatient Care
  • Labwork & Tests
  • Renal Dialysis
  • Diabetic supplies
  • Durable Medical Equipment (wheelchairs, CPAP, walker, etc)
  • Occupational & Physical Therapy
  • Mental Health (expanded behavioral health benefits are covered by Medicaid, through a Behavioral Health Managed Care plan)

If you have Medicare coverage, you have the option to retain Traditional Medicare or enroll in a Medicare Advantage (Part C) plan provided by an insurance company. For individuals eligible for both Medicare and Medicaid, there are specialized Medicare Advantage plans called "Dual Special Needs" plans or D-SNPs. These plans may offer additional benefits such as transportation to medical appointments, over-the-counter wellness items, home-delivered meals, and care coordination.

Medicaid is your supplement or second insurance and covers:

  • Most co-pays and costs that Medicare doesn’t cover. Depending on your income, Medicaid may also pay for your Part B premium.
  • Dental & Vision
  • Chiropractor
  • Podiatrist
  • Transportation to Medical Appointments through Pennsylvania’s Medical Assistance Transportation Program (MATP)
  • Other services that Medicare won’t fully cover or authorize

Long-Term Services & Supports (LTSS) refer to assistance provided in your home to help you maintain independence. These services are available if you undergo an assessment by the Office on Aging and your primary care doctor determines that you require help with daily tasks such as bathing, dressing, meal preparation, navigating stairs, and managing finances or medications.

  • Personal Care (a direct care worker or attendant that you can hire directly, or get through a home care agency)
  • Home Modifications like a ramp, stairlift, or handrails to make your living environment safe and accessible
  • Nursing Home Transition (moving back home or to an apartment)
  • Non-Medical Transportation (to attend religious services, go to the grocery store, visit family, or other activities important to you)

Home & Community-Based "Waiver" Services under CHC

Your Community HealthChoices plan aims to enhance the synergy between Medicare and Medicaid, facilitating better coordination of care with your behavioral health plan.

If you are currently receiving in-home services and support through a Medicaid "waiver" program administered by the Office of Long-Term Living:

  • You’ll continue to receive those same services under Community HealthChoices
  • Your new CHC health plan must work with all of your current long-term care providers (through June 30th)
  • Your current Service Plan that outlines what kind of in-home care & support you get cannot be reduced (through June 30th)
  • After June 30th, it will be necessary for you to utilize long-term care providers that are included in your CHC plan's network.
  • After June 30th, your CHC plan collaborates to tailor your Person-Centered Service Plan to your needs, values, and goals.
  • Pennsylvania’s Independent Enrollment Broker (1-844-824-3655), or your CHC plan, can tell you which providers are in your plan’s network — just call them and ask!

Which specific types of long-term services and supports are included in the coverage?

  • A personal care attendant to help with bathing, dressing, making meals, light housekeeping, and other everyday needs
  • Equipment and modifications to your home or car to make them safe for you, like hand controls in the car or a stairlift
  • Help keeping your home environment clean, including from bugs and mold
  • Transportation for both medical and social needs (getting to the doctor, the grocery store, religious services, a job or volunteer activity etc.)
  • Home-delivered meals and help building healthy, nutritious eating habits
  • Help finding employment and safe, stable housing
  • Service coordination, to arrange for all the long-term services you need
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