David Gates | Senior Attorney, Pennsylvania Health Law Project, CILCP Board Member : Explains Community Health Choices
Beginning in Fall of 2017, there will be a new Managed Care Model, entitled Community HealthChoices in Pennsylvania. Community HealthChoices directs services to be administered by a Managed Care Organization Add a Tooltip Text or MCO. This will affect people with disabilities who are on waiversAdd a Tooltip Text , and individuals who are on MedicareAdd a Tooltip Text and Medical AssistanceAdd a Tooltip Text .
Overview from Janetta Green Acting CEO of the CILCP
— Janetta Green, Acting CEO of the Center for Independent of Living Central Pennsylvania
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)
- IndependenceAdd a Tooltip Text waiver
- Attendant Care waiver
- *OBRA WaiverAdd a Tooltip Text (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)
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.
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 providerAdd a Tooltip Text, the state will choose one for you.
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 PlanAdd a Tooltip Text
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.
How to get started:
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.