What is Pennsylvania’s Community HealthChoices Program?

Pennsylvania’s Community HealthChoices (CHC) is a relatively new Medicaid program that uses managed care organizations (MCOs) to eliminate healthcare confusion and see that you get the health and wellness you need. Managed care programs historically have improved the level of care and long-term support needed to maintain higher levels of physical health for their community members.

The CHC managed care program was designed to:

• Make Medicare, Medicaid, and additional services work more fluidly, so you can maximize all the benefits and medical assistance available.
• Make home living accommodations like ramps, handrails and vehicle modifications so people can live on their own and safe
• Improve quality of life situations to provide more long-term services and support, deliver proactive healthcare, and support underserved populations such as individuals with mental disabilities or physical disabilities, financial inefficiencies, and behavioral health needs.

• Make Medicare, Medicaid, and additional services work more fluidly, so you can maximize all the benefits available.
• Make home living accommodations like ramps, handrails and vehicle modifications so people can live on their own and safe
• Improve quality of life situations, proactive healthcare, places to live and transportation inefficiencies

Who is covered by CHC?

• Residents in the state of Philadelphia that are dually eligible for both Medicare and Medicaid
• Those in Medicaid Nursing homes
• Those on waiver programs which allows for receiving services in-home vs. a long term care nursing facility.

What is changing with CHC rollout?

CHC is replacing the ACCESS card, your Medicaid benefits from the state will come through the CHC health plan that you pick or were assigned too.

There are 3 MCO’s to choose from, and you can change your plan at any time:

• AmeriHealth Caritas (aka Keystone First) https://www.keystonefirstchc.com/index.aspx
• PA Health & Wellness https://www.pahealthwellness.com/members/ltss.html
• UPMC Community HealthChoices https://www.upmchealthplan.com/chc/

Applying for Community Health Choice Isn’t necessary.

Since it is a state mandatory managed care program for Pennsylvanians who qualify, the state will send you information on eligibility requirements, how to enroll and choose your MCO.

If you missed the package sent out you can check on your enrollment at http://enrollchc.com. If you did not pick an MCO yourself and you are eligible for benefits, the state by default will assign you an MCO.

Will this change my Medicare?

Not on the surface, however if you have a Medicare plan and in CHC you may want to check that your providers will accept your new MCO coverage. Essentially you will have two networks now because providers are also contracting with MCOs.  This could lead to some disconnects. Your Medicare plan and Medicaid MCO may not align correctly with your doctors and specialists. This could cause some frustration at the doctor’s office or even unforseen out of pocket costs.

Here are some examples:

Let’s say you have Cigna Health SpringsTotal Care and your primary doctor is taking your Medicare Plan, but your MCO is different than your primary care doctors.

Suppose you have Original Medicare and your provider is not contracted with any MCO
Or your providers are contracted with a different MCO than you.

If you receive Home Health Care and they are contracted with a different MCO than you

There are a number of different circumstances but In each of these scenarios there could be a disconnect or a reason for a switch to a matching MCO to your providers. This will reduce further issues. In some cases when seeing multiple Doctors and specialists you could have a hard time seeing all of them because of the providers varying MCO contracts, in that case you would need to make some adjustments or even find a new dr of specialist.

Not sure if you are enrolled correctly in Community Health Choices (CHC)?

Give us a call or ask for a benefits review and we can help you find out with some basic information. 844 611 ZERO (9376)

Frequently Asked Questions (FAQ’s)

Who is eligible for community health choices?

Individuals are eligible for CHC if they are 21 years old or older and:

• Dually eligible for Medicare and Medicaid. In CHC, that includes individuals with Medicare
  Part A and/or Part B; or
• Qualify for Medicaid long-term services and supports (LTSS) because they need the level of care
  provided by a nursing facility.

I lost my CHC card, but I know my MCO?

Here are the MCO organizations and their contact information to call and request a new card.

AmeriHealth Caritas Pennsylvania (Southwest zone)
1-855-235-5115 (TTY: 1-855-235-5112)
www.amerihealthcaritaschc.com

Keystone First (Southeast zone)
1-855-332-0729 (TTY: 1-855-235-4976)
www.keystonefirstchc.com

Pennsylvania Health & Wellness
1-844-626-6813 (TTY: 1-844-349-8916)
www.PAHealthWellness.com

UPMC Community HealthChoices
1-844-833-0523 (TTY: 1-866-407-8762)
www.upmchealthplan.com/chc

I lost my card and DO NOT know my MCO provider?

You can order through the automated system by calling 1-844-824-3655.

You’ll need to have the following information ready:

• Last 4 of your social
• Date of Birth
• Physical Address

I started getting billed from my doctor.

If you were previously not being billed by your doctor and now you are receiving bills, there is likely an issue with you doctor and their contract with the MCO you are assigned to.

What does that mean?

It means you need to confirm your current doctor is accepting CHC and contracted with the same MCO as you.  Below is a link to check if your doctor accepts CHC.

Check provider here https://www.enrollchc.com/choose/find-provider

My doctor is not accepting CHC, what do I do?

Unless you are willing to pay out of pocket you may need to switch to a participating doctor so you can continue to access your services.

How can I switch MCOs?

https://www.enrollchc.com/enroll

How can I switch my Medicare Plan to coordinate with my MCO?

Switching plans can only occur by working with an insurance agent who is licensed and certified to sell Medicare plans in the state of Philadelphia.

It is best to speak with an agent who can access multiple insurance companies network physician lists as well as other tools to assist with matching doctors and programs.

As a dually eligible Medicare and Medicaid beneficiary, you are entitled to plans that may further enhance your healthcare experience as well as enrollment opportunities to make plan changes outside of the annual election period.

How can I get help with this?

Our team at BroadZero is here to help you.

Call us directly and speak to a live state licensed insurance agent at 844-611-9376 or Schedule a benefits review and we can help you coordinate the best coverage option for your individual needs. We’re here to help and make this easy for you.