What benefits will CHC enrollees receive?

Those who are enrolled in the CHC program will be eligible to receive the following benefit coverage:

Health Care:

  • All CHCs must offer a D-SNP program (an insurance product that manages both Medicare and Medicaid)
  • All CHCs must offer the basic Medicaid Adult benefit package
  • Although the CHC must offer the two options noted above, persons enrolled in the CHC program can choose to get their health care through a D-SNP program offered through a different health plan or get the health benefit through a traditional Medicare plan.

Long-Term Services and Supports (LTSS):

  • All CHCs must offer LTSS if a member is determined to be Nursing Facility Clinically Eligible (NFCE). There is a formal process for assessing whether someone meets these criteria.
  • Examples of LTSS and Home- and Community-Based Services (HCBS) include: adult daily living services, home adaptations, home-delivered meals, home health aide, pest eradication, structured day habilitation, residential habilitation, etc.

Service Coordination:

  • All CHCs must provide service coordination as an administrative function of the Community HealthChoices managed care organization (CHC-MCO).
  • All CHCs must provide services coordination either directly themselves or through contracted service providers.
  • Service coordinators lead the person-centered service planning process and oversee the implementation of Person-Centered Service Plans (PCSP).
  • Community Care members can continue to receive BH case management services in addition to the services coordination received through CHC.

Will the CHC program result in Community Care getting new members?

The CHC program is primarily for people who have dual eligibility (Medicare and Medicaid); therefore, most of the people who will be enrolled in this program are already enrolled and eligible to receive behavioral health benefits through a behavioral health MCO.

Will the CHC program result in any additional people becoming eligible for behavioral health coverage?

Some people will become eligible for behavioral health benefits who were not in the past. They will primarily come from two groups:

  • Some people who reside in nursing homes that are paid for by Medicaid will be enrolled in the CHC program and will become eligible with Community Care. This will be a new population who would not have been eligible prior to the CHC program. They will have distinct behavioral health needs.
  • The state of Pennsylvania has several “waiver” programs that provide a variety of home- and community-based supports. One program is called the “Aging Waiver.” Individuals who are enrolled in this program will also be enrolled in the CHC program and become eligible for BH benefits through a BH-MCO.

I keep hearing about the waiver programs? What are they?

Home- and community-based waiver programs are available to qualified individuals who wish to remain in their homes rather than having to reside in a nursing home or other institutional setting. They provide medical and non-medical long-term care and support services to help people remain independent and living in their home. All State Medical Assistance programs must follow federal guidelines. They are called “Waiver” programs because the State has asked the federal government to waive or not apply certain rules under the MA program.

What is an Independent Enrollment Broker (IEB)?

  • The state has hired an IEB to help people with the eligibility and enrollment process for CHC.
  • This website takes you directly to the IEB page. You can direct members to this website as it provides instructions on how to enroll in CHC: www.enrollchc.com
  • Members can call to talk to an IEB: CHC Helpline 1-844-824-3655.

Does enrollment in the CHC program affect eligibility for HealthChoices Behavioral Health coverage?

No. Anyone who is enrolled in the CHC program will continue to get their HealthChoices Behavioral Health coverage from the BH-MCO in the county in which they reside. If a member is eligible with Community Care, they will remain so unless they move to a county where Community Care is not the BH-MCO.

Will there be significant changes in services for people who are enrolled the CHC program who were already receiving services through waiver programs, nursing homes, etc.?

The CHC program has a Continuity of Care provision. Below are some details taken from materials provided by DHS.

  • MCOs are required to contract with all willing and qualified existing Medicaid providers for 180 days after CHC implementation.
  • Participants may keep their existing providers for the 180-day continuity of care period after CHC implementation.
  • For nursing facility residents, participants will be able to stay in their nursing facility as long as they need this level of care, unless they choose to move.

Do CHC participants get to choose which CHC they want to enroll with?

Yes - all the participants were mailed information with instructions on how to choose a CHC and enroll. The IEBs have also been available to help members evaluate the plans and make a decision. If someone does not like the CHC that they signed up with, they can choose to sign up with a different plan. They can change as often as they like. If someone does not enroll with a specific CHC, they will be auto assigned to one but can still change it if they want to.

How can I find out if someone is enrolled in the CHC program?

This information is now available in the state’s Electronic Verification System (EVS).

Why is it important that I know about CHC?

There are many reasons:

  • It is important to take a holistic view of health and wellness. Making sure that physical and behavioral health are integrated and coordinated is important to meeting this goal.
  • You may get some questions from members with whom you are working. It is important to have a basic understanding of the program in order to assist them.
  • You may get invited to participate in a Person-Centered Service Planning (PCSP) meeting.
  • You may find it is useful to seek additional training and resources for working with an older population or individuals with more complex physical and behavioral health needs.
  • Some of the members you work with might benefit from receiving LTSS.

Who can I contact if I need to coordinate or collaborate with one of the CHCs?

All the CHCs are required to have a Behavioral Health Coordinator who is a behavioral health professional and located in Pennsylvania. Their job is to coordinate care needs with the BH-MCOs and will also be available for purposes of coordination and collaboration and are the best place to start. The service coordinators at each of the CHCs will also be very involved in any coordination and collaboration activities.

CHC MCO Contact Information: