Overview of Community Health Choices from Janetta Green CEO of the CILCP
As you may have heard, a new Managed Care Model referred to as Community HealthChoices, is being implemented in Pennsylvania. This change has an impact on people with disabilities who are receiving waivers as well as those on Medicare and Medical Assistance. At the Center for Independent Living of Central Pennsylvania, we realize that change can be difficult and adjusting to this new Managed Care Model may feel overwhelming. However, we will work diligently to help guide you through this transition. Our website offers streamlined content, highlighting the steps you need to take and the information you need to know about the transition. Employees at the Center for Independent Living of Central Pennsylvania are available to answer any questions you may have throughout this process, and our Living Well Hotline will offer call-in assistance to all consumers. The Center for Independent Living of Central Pennsylvania will work with you as we adjust to this new model together, and will make sure you have the information you need to transition smoothly.
— Janetta Green, CEO of the Center for Independent of Living Central Pennsylvania
Pennsylvania is implementing a new health care model called Managed Care or Community Health Choices. The Office of Long Term Living will implement Phase III, Lehigh/Capital Region, on January 1, 2020 for (1) people with disabilities who are receiving waivers and (2) people who receive Medicare and Medicaid assistance.
The Center for Independent Living of Central PA realizes that change may be difficult and adjusting to this new model may be overwhelming. However, our staff is available to guide you through this transition. We are available to answer your questions and ensure you have the information you need to transition smoothly.
Community Health Choices Tool Box
Participant Information Sessions
PA Department of Human services is hosting over 70 community meetings for you to learn about Community Health Choices (CHC) and give you the opportunity to ask questions. Space is limited! Find a meeting (HYPERLINK—find a meeting) near you and register today!
- PA Department of Human Services: Community Health Choices (HYPERLINK)http://www.healthchoices.pa.gov/info/about/community/
- Independent Enrollment Broker: Community Health Choices (HYPERLINK)
- PA Health Law Project (HYPERLINK)
- PA Assistive Technology Foundation (HYPERLINK)
Be sure to take a few minutes to watch this video. Attorney David Gates does a great job of introducing you to Community Health Choices.
David Gates | Senior Attorney, Pennsylvania Health Law Project, CILCP Board Member : Explains Community Health Choices
Beginning in Fall of 2017, there will be of a new Managed Care Model, entitled Community HealthChoices in Pennsylvania. Community HealthChoices directs services to be administered by a Managed Care Organization or MCO. This will affect people with disabilities who are on waivers, and individuals who are on Medicare and Medical Assistance.
And if you still want more information, then the following training is for you! The CILCP hosted a two part training with David Gates in June 2019. Each part is approximately two hours and is jam packed with information!
Important Dates to Remember and Additional Information :
OLTL will mail flyer about CHC and LIFE program
Aging Well will send a letter about participant information sessions
Round 1 “Pre-Transition” notices mailed
Round 2 & 3 “Pre-Transition” notices mailed
Round 1, 2, 3 Enrollment packets mailed
Deadline to select a plan. If you do not select a plan one will be selected for you.
Deadline to change plan
Begin using your new plan
Participant Information Sessions
You will be enrolled in this new program if you are 21 or older AND:
- Have Medicare and Medical Assistance
- OR are on ONE of the following waivers:
- Aging waiver
- CommCare waiver (for people with traumatic brain injury)
- Independence waiver
- Attendant Care waiver
- * Obra Waiver (only if the individual has significant physical limitations)
- OR are on Medical Assistance (MA) or become MA eligible in nursing facilities
- OR become NFCE (nursing facility clinically eligible)
Choosing a new provider:
Community HealthChoices will replace existing waivers, and be administered by one of the three Managed Care Organizations listed below. You will be asked to choose between the following Managed Care Organizations:
- AmeriHealth Caritas Pennsylvania
- UPMC Community HealthChoices
- Pennsylvania Health and Wellness
It’s important that you exercise your choice when prompted, because if you do not select a provider, the state will choose one for you.
This health care model is not optional:
If one of the items listed below the heading “You will be enrolled in this new program if you are 21 or older AND” applies to you, then you will automatically be enrolled in Community HealthChoices. We understand that this change may raise a few questions and spark fear of uncertainty. However, there are numerous protections put in place to ensure that individuals continue to receive the support and services they need, and organizations such as the Center for Independent Living of Central Pennsylvania are available to help you through this transition.
If you are on Medicare:
You will have a choice of one of the following:
- Receive care through a Medicare Managed Care Plan (a sister plan to Community HealthChoices)
- Keep your original Medicare
- Receive care through a Medicare Advantage Plan
Differences in Managed Care Organization providers:
Each of these Managed Care Organizations will have their own network of providers. If you switch managed care plans, the provider that you currently use for care might not have a contract with your new Managed Care Organization. If the provider does not have a contract with your Managed Care Organization, you may choose to switch to a different provider. It will be important to review the Managed Care Organization options, and select the organization that has a contract with your service provider, if you would like to continue receiving services from them.
You will receive a letter that explains Community HealthChoices and contains information about an Enrollment Broker. Once you receive this information, you will need to contact the Enrollment Broker.
The Enrollment Broker will help you choose your provider. They will offer information about which providers are enrolled in each of the three Managed Care Organizations, and help guide your decision.
If you are currently on a waiver, you will continue to receive your current services from your current provider, for six months starting at the point in which you are enrolled in the managed care plan. After six months, if you are using a provider that is not enrolled, you will have to switch providers.
How waiver services will change:
The waiver services will be the same as they are now, with some additions. There will be:
- Attendant care
- Home modifications
- New employment services
There still will be participant-directed or consumer-employer model services, as there are now.
Committed to a smooth transition:
The Center for Independent Living of Central Pennsylvania looks forward to partnering with consumers, to make sure that this transition goes smoothly, and people continue to receive all the services they require to maintain their lifestyle and live well in the community. We will be happy to work with you in the future.