This is the second article in a series about Community HealthChoices.
Community HealthChoices is a new Medicaid program that will start in southwestern Pennsylvania on January 1 (in Pennsylvania, our Medicaid program is called Medical Assistance). It will affect tens of thousands of older adults and people with disabilities who live in this 14 county region and who fall into one of these target groups:
People who are in a nursing home paid for by Medicaid;
People who are getting services at home through the Aging Waiver or through one of these Waivers: Attendant Care, COMMCARE, Independence or OBRA;
People who simply have both Medicare and Medicaid insurance and who are not receiving any Medicaid long term care services.
Are there exceptions? Yes. Even if someone fits into one of the above groups, the person will not go into Community HealthChoices if he or she:
- is in a LIFE program or
- resides in a state veteran’s home or other state-operated nursing facility or
- is getting services through an Intellectual Disability or Autism Waiver, or is on the waiting list for one of these Waivers or
- is in the OBRA Waiver and was notified that he did not meet a nursing facility level of care.Those going into Community HealthChoices will soon receive information about choosing and enrolling into one of the three CHC plans chosen by the state: Amerihealth Caritas, PA Health & Wellness or UPMC Community HealthChoices. The CHC plan will become the person’s Medicaid health insurance. If someone is in a nursing home or getting Waiver services at home, the CHC plan will also become their coverage for these long-term care services. If the individual going into CHC also has Medicare or other health insurance, it is important to remember that CHC only impacts their secondary Medicaid coverage and does not affect or change their Medicare or other insurance coverage.
Notices coming soon to those moving to CHC
Important things are happening this fall to prepare for the start of CHC. By early October, people who will move to Community HealthChoices should receive a letter telling them about the new program and how it will work. This letter will also tell people that they can appeal the state’s decision to move them into CHC if they do not fit into one of the three target groups or if they fall into one of the exceptions listed above.
Shortly after receiving this letter, consumers will be sent an enrollment packet. This packet will give information about each of the three CHC plans. It will also include information about how to contact the state’s Independent Enrollment Broker by phone or online to enroll into a plan. The deadline to enroll will be November 15. Those who do not choose and enroll into a CHC plan by this date will be auto-assigned to a plan by the state. All plan enrollments will go into effect on January 1, 2018.
Things to consider when choosing a CHC plan
Everyone going into CHC is encouraged to consider their options, choose a plan and enroll by November 15. If someone chooses a plan that turns out not to be a good fit for them once CHC starts, they can always change their plan at any time during the year.
People living in a nursing home when CHC starts on January 1 can stay in that nursing home as long as they want and as long as they need those services no matter which CHC plan they choose; however, these residents (or their family members/personal representatives) should talk to nursing home staff if they have questions and to determine which CHC plan(s) may be a good choice for them.
People who are living in the community have other considerations. For their medical care (such as doctor visits and tests), they should check with their current medical providers to see if they are participating in any of the CHC plans. They should then choose a plan that allows them to continue to see most, if not all, of their providers. For those who have Medicare, the CHC plan cannot require providers to be in the plan’s network to pay second. As a result, for services covered by Medicare, the CHC plan must pay second to Medicare for services and treatment no matter which CHC plan the person chooses.
Individuals who are receiving services at home through a Waiver program should check with their current Waiver providers, including their service coordinator, to see which of the CHC plans they will participate in. They should then choose a plan that will allow them to continue being served by those providers. Waiver participants are encouraged to talk to their service coordinator if they have questions and for help determining which CHC plan(s) may be a good choice for them.
Where to turn for help
Those receiving mailings about their move into CHC will be given a phone number to call if they have questions and a website to go to for more information. In addition, you can:
- contact your service coordinator if you are in a Waiver program.
- contact nursing home staff if you live in a nursing home.
- call APPRISE at (800) 783-7067 for questions about Medicare coverage and options.
- call the PA Health Law Project at (800) 274-3258 if you are having problems enrolling into a CHC plan or understanding your rights under CHC.This article was written by the PA Health Law Project, which provides free legal help to older adults with limited income. To learn more, call PHLP’s Helpline at (800) 274-3258 or visit phlp.org.
• October 11 at 2:30 p.m. at Carnegie Free Library of Braddock, 419 Library St, Braddock.
• October 14 at 2:30 p.m. at Carnegie Library of Pittsburgh – Downtown Branch, 612 Smithfield St., Downtown.
• October 17 at 2:30 p.m. at Carnegie Library of Pittsburgh – Lawrenceville Branch, 279 Fisk St., Lawrenceville.
Light refreshments will be served. Reservations are helpful but not necessary. To learn more, contact Erin Ninehouser at (412) 863-1047 or firstname.lastname@example.org.