What is Community HealthChoices!
COMMUNITY HEALTHCHOICES (CHC) is Pennsylvania’s mandatory managed care program for dually eligible individuals and individuals with physical disabilities — serving more people in communities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. When implemented, CHC will improve services for hundreds of thousands of Pennsylvanians.
CHC will improve health services for many thousands of people in Pennsylvania. It will give them the chance to have a better quality of life.
Who qualifies for CHC?
You will be automatically enrolled in CHC if you are age 21 or older and
- Get both Medicare and Medicaid, or
- Get LTSS in the Attendant Care, Independence, COMMCARE, or Aging waivers, or
- Get LTSS in the OBRA waiver and qualify clinically for a nursing facility, or
- Get care in a nursing home paid for by Medicaid
You do not qualify for CHC if you:
- Get LTSS in the OBRA waiver and do not qualify clinically for a nursing facility level of care; or
- Have an intellectual or developmental disability and get services through the Department of Human Services Office of Developmental Programs, or
- Live in a state-operated nursing facility, including the state veterans’ homes
What does CHC cover?
CHC covers the same physical health benefits you have now in your Medicaid Adult Benefit Package. With CHC, all of your Medicaid and prescription drug benefits are in one health plan. To see a list of services covered by all plans, go to Physical and behavioral health benefits.
If you receive LTSS, you will now get those services and supports through your CHC health plan. To see a list of LTSS covered by all plans, go to Long-term services and supports.
All health plans have care coordination to manage your health care. To learn more, go to Care coordination.
What happens next?
You will choose a health plan and primary care practitioner (PCP).
- Your health plan uses groups of doctors, hospitals, clinics, and other health care providers. They work together to meet your health care needs.
- Your PCP is a doctor or other provider who gives you most of your health care.
Use this website to help you choose the best health plan and PCP for you.
Please note: If you have Medicare and Medicaid and are enrolled in a Medicare Advantage plan, you will not have to change your Medicare PCP.
If you are in a Living Independence for the Elderly (LIFE) program, you can stay in LIFE. You will not be placed in the CHC program unless you ask to change.
If you are enrolled in CHC and want to be in LIFE instead, you can apply to LIFE to find out if you qualify. To qualify for LIFE, you must:
- Be age 55 or older
- Meet the level of care needs for a skilled nursing facility or a special rehabilitation facility
- Meet your local County Assistance Office financial requirements or be able to pay on your own
- Live in an area served by a LIFE provider
- Have a LIFE provider decide you can be served safely in the community
To find a LIFE provider near you visit the LIFE program website.