Community HealthChoices: What you need to know now

This is the first in a two-part series about Community HealthChoices.

Big changes are coming for people who receive long-term care services through Medicaid—either in their home or in a nursing home—and for people who have both Medicare and Medicaid. A new program called Community HealthChoices starts in 14 counties in southwestern Pennsylvania on January 1, 2018.

When Community HealthChoices starts, the following people will get their Medicaid coverage and long-term care coverage through managed care plans:

1) Those who are in a nursing home paid for by Medicaid.

2) Those in the Aging Waiver or any of the following Waivers: Attendant Care, CommCare and Independence. People in the OBRA Waiver may be impacted depending on their level of care.

3) Those with both Medicare and Medicaid, unless they are eligible for services through the Office of Developmental Programs because they have an Intellectual Disability or Autism.   

Community HealthChoices will not impact people in the LIFE Program. LIFE will continue to exist as an alternative option for those ages 55 and older who need long-term care.

What’s changing under Community HealthChoices?

Community HealthChoices (CHC) will affect people in different ways. This article focuses on how it will affect people ages 60 and older who fall into one of the three target groups noted above. Primarily, CHC changes the way these groups of people get their Medicaid coverage. For people in nursing homes and Aging Waiver, it changes who pays for their long-term care services.

Those going into Community HealthChoices will receive details describing the program by mail, including enrollment packets that will outline available plan choices and how to enroll in a plan.

People with both Medicare and Medicaid

Most people going into Community HealthChoices have Medicare in addition to their Medicaid coverage. If this is true for you, please know that Community HealthChoices will not change your Medicare coverage or your Medicare choices. It will only change your secondary Medicaid coverage.

You can still get your Medicare through Original Medicare (using the red, white and blue card) or a Medicare Advantage plan (Medicare managed care). Medicare will still pay first and cover the vast majority of healthcare services you get. Also, Medicare Part D will continue to pay for your prescription drugs, and you will have full Extra Help so that you pay only small co-pays for your prescription drugs.

You will need to choose and enroll into a CHC plan later this fall. If you do not make a plan choice, one will be chosen for you.

When Community HealthChoices starts in January, your CHC plan’s identification card will replace your ACCESS card as your secondary insurance. You will need to show both your Medicare card and your CHC plan card when you get health care services. Your CHC plan will cover some services that your Medicare may not, such as dental care.

If you also get long term care services in a nursing home or at home through a Waiver, read on for more information about how Community HealthChoices will impact you.

Nursing home residents

If you are in a nursing home being paid for by Medicaid, you pay the nursing home the “patient pay amount” set by your local County Assistance Office. Medicaid covers the rest of your nursing home bill. You also get Medicaid health insurance through an ACCESS card.

When Community HealthChoices starts, you will need to pick a CHC plan. After January 1, this plan will pay the nursing home for your care. You will continue to pay your patient pay amount. Your CHC plan will also replace your ACCESS card as your Medicaid health insurance. If you do not join a plan on your own, one will be chosen for you.

Please note that if you are in a nursing home on January 1 when CHC starts, you have the right to remain in that nursing home as long as you want. No matter what Community HealthChoices plan you choose, your plan must pay the nursing home for your care whether or not the nursing home is in your CHC plan’s network.

Community HealthChoices will not change your Medicare or any other health insurance you have.

People in the Aging Waiver Program

If you are in the Aging Waiver, you also have Medicaid health insurance through the ACCESS card. You use your ACCESS card when you get healthcare services. The Aging Waiver pays for the long-term care services you get at home. You work with a service coordinator to develop a service plan that details what services will be paid for by the Waiver. You can choose to get those services from any provider enrolled in the Aging Waiver. For certain services, you can use the “consumer-directed model” where you, or your representative, can choose to hire and supervise the person who helps you.

When Community HealthChoices starts, you will have to enroll into a CHC managed care plan. If you do not make a choice, one will be chosen for you.

After January 1, your CHC plan will provide your Medicaid coverage and pay for your Waiver services. You will need to use your CHC plan identification card, instead of your ACCESS card, when you get healthcare. You can continue to use the consumer-directed model under the new program.

Community HealthChoices will not change your Medicare or any other health insurance you have.

For more information

People who have questions about Community HealthChoices can contact the Pennsylvania Health Law Project Helpline at (800) 274-3258. In October issue of Senior News, we will focus on choosing and enrolling into a Community HealthChoices plan.

This article was written by the PA Health Law Project, which provides free legal help to older adults with limited income. PHLP’s Helpline number is (800) 274-3258. To learn more, visit phlp.org.

PHAN offers free “community conversations” about long-term care in Pennsylvania

The Pennsylvania Health Access Network (PHAN) is inviting the public to a series of free community events focused on long-term care.

“It’s important that the people responsible for providing coverage and care to seniors have a clear picture of what they need to feel good, stay connected to the community, and live independently,” says PHAN’s consumer engagement manager Erin Ninehouser. “We invites you to share your experiences and ideas for improving long-term care as we work to ensure that the way our state provides these vital services to seniors and people with disabilities actually meets the everyday needs people have.”

This is a critically important time for these conversations, as Pennsylvania embarks on a major overhaul of how long-term services and supports are provided. Community HealthChoices—the state’s new managed care system that will serve Pennsylvanians with both Medicare and Medicaid and those currently receiving long-term services and supports through the Office of Long-Term Living—begins January 1, 2018 in southwestern Pennsylvania. Attendees at the community events will have an opportunity to learn about this new program, how it works, what their options for coverage will be, and where to turn locally for one-on-one help with getting services.

Upcoming meetings:

• September 8 at 2:30 p.m. at Beaver Area Memorial Library Community Room, 100 College Ave., Beaver.

• September 12 at 2:30 p.m. at Butler Area Public Library, 218 N. McKean St., Butler.

September 13 at 2:30 p.m. at Carnegie Library of Pittsburgh – Knoxville Branch, 400 Brownsville Rd, Knoxville.

September 14 at 2:30 p.m. at Millvale Community Library, 213 Grant Ave, Millvale.

September 18 at 2:30 p.m. at People’s Library – New Kensington, 880 Barnes St, New Kensington.

Light refreshments will be served. Reservations are helpful but not necessary. To learn more, contact Erin Ninehouser at (412) 863-1047 or erin@pahealthaccess.org.

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