About PA Health & Wellness

PA Health & Wellness Community HealthChoices (CHC) Helping Pennsylvanians Get the Care and Support They Need

Helping You Stay Healthy, Safe and Independent

As we get older, everyday activities can become more difficult. Getting dressed, preparing meals, managing health problems or getting to medical appointments may not be as easy as they once were. For family members, making sure a loved one has the right care can also become a challenge.

PA Health & Wellness understands that getting older or living with a disability should not mean giving up your independence.

Through Pennsylvania's Community HealthChoices (CHC) program, PA Health & Wellness helps eligible older adults and adults with physical disabilities receive health care benefits and, when they qualify, long-term care services and support.

Whether you need help understanding your health coverage, finding doctors or arranging care at home, PA Health & Wellness works to make getting the right services easier.

The goal is simple: Help people receive the care they need while supporting their health, independence and quality of life.

What Is Community HealthChoices (CHC)?

Community HealthChoices, often called CHC, is a Pennsylvania Medicaid health care program for eligible adults age 21 and older.

It is designed for people who have both Medicare and Medicaid, as well as certain adults who need long-term care services because of a disability or ongoing health condition.

PA Health & Wellness is one of the health plans that provides Community HealthChoices coverage in Pennsylvania.

CHC helps people manage their health care benefits. For those who qualify for additional long-term support, the program may also help arrange services at home or in the community.

These services can make a real difference for someone who wants to remain in familiar surroundings but needs extra assistance.

For example, an older adult may be able to manage most activities independently but need help bathing, dressing or preparing meals. Another person may need nursing care, medical equipment or assistance after a serious illness.

Community HealthChoices is designed to help eligible individuals get the right level of care based on their personal needs.

Who Can Qualify for PA Health & Wellness Community HealthChoices?

You may qualify for Pennsylvania Community HealthChoices if you are age 21 or older and meet the state's Medicaid eligibility requirements.

The program generally serves:

• Adults who have both Medicare and Medicaid. These individuals are sometimes called "dual eligible" because they receive benefits from both programs.

• Older adults who need long-term care. This may include people who need ongoing help with everyday activities or have health conditions that make independent living more difficult.

• Adults with physical disabilities. Eligible individuals who need long-term services and support may qualify even if they are younger than 65.

• People receiving qualifying Medicaid long-term care services. This can include care provided at home, in the community or in a nursing facility.

Not everyone enrolled in Community HealthChoices qualifies for home care or other long-term services. Eligibility for these additional benefits is determined through Pennsylvania's assessment and approval process.

If you are unsure whether you or a family member qualifies, the first step is to check your eligibility.

What Services Are Available Through Community HealthChoices?

PA Health & Wellness offers a range of health care benefits through its Community HealthChoices plan.

For participants who qualify for Long-Term Services and Supports (LTSS), additional services may be available to help with everyday living.

The services a person receives depend on their health, individual needs and approved benefits.

Help With Everyday Activities at Home

For many older adults, staying in their own home is important. Being surrounded by familiar belongings, neighbors and family can bring comfort and peace of mind.

Eligible Community HealthChoices participants may qualify for personal assistance services that help with everyday tasks such as:

• Bathing and personal hygiene

• Getting dressed

• Moving safely around the home

• Preparing meals and eating

• Other daily activities that have become difficult

These services can help individuals continue living at home while receiving the support they need.

Home Health Care and Nursing Services

Some individuals need more than help with daily activities. They may also need medical care because of an illness, injury or ongoing health condition.

Depending on eligibility and medical needs, covered services may include home health nursing, home health aide services and certain types of therapy.

These services can help people manage their health and receive appropriate care without having to leave home for every need.

Help With Meals and Nutrition

Eating healthy meals is an important part of staying well, especially for older adults managing medical conditions.

For eligible individuals receiving long-term services, Community HealthChoices may provide home-delivered meals or nutritional counseling when these services are part of an approved care plan.

This can be especially helpful for someone who has difficulty shopping, cooking or preparing meals independently.

Medical Equipment and Home Safety

Sometimes small changes can make a big difference in helping someone remain safe at home.

Community HealthChoices may cover certain medical equipment, assistive technology or home modifications for eligible participants.

Depending on a person's needs and approved benefits, this could include equipment that makes daily activities easier, a personal emergency response system or changes that improve access and safety in the home.

These supports can help reduce everyday challenges and make independent living more manageable.

Respite Care and Family Caregiver Support

Caring for a parent, spouse or loved one can be rewarding, but it can also be physically and emotionally demanding.

Family caregivers often balance their caregiving responsibilities with work, children and other family needs.

For eligible individuals receiving long-term services, respite care may be available. Respite provides temporary care for a loved one so their regular caregiver can take a break or attend to other responsibilities.

PA Health & Wellness also offers caregiver information and resources to help families better understand and manage their loved one's care.

What Is a Service Coordinator?

One of the most helpful parts of Community HealthChoices for people receiving long-term services is having a service coordinator.

A service coordinator helps eligible participants understand their needs, explore available services and put together a plan for care.

Think of this person as someone who helps connect the pieces of your care.

For example, if an older adult needs help at home, the service coordinator can work with that person to identify appropriate covered services and help arrange approved support.

A service coordinator may also help with:

• Understanding available long-term care benefits

• Developing a personal care plan

• Connecting with approved service providers

• Coordinating services with doctors and other health professionals

• Reviewing needs when health or living circumstances change

• Finding additional community resources

The participant plays an important role in deciding what services are best for their situation.

Family members and caregivers may also be involved in planning care when the participant wants their help.

Can Community HealthChoices Help Someone Avoid Moving Into a Nursing Home?

Many older adults would prefer to remain at home for as long as possible.

For some people, the right combination of personal care, medical services, home modifications and family support can make that possible.

Community HealthChoices helps eligible participants explore care options that support living at home or in the community when appropriate.

For example, a senior who needs assistance with bathing, dressing and meals may be able to receive approved services at home rather than relying entirely on family members.

However, not everyone can safely remain at home, and Community HealthChoices does not guarantee that nursing home care can be avoided.

The goal is to help each eligible participant receive care in a setting that meets their needs while respecting their preferences and independence.

How Does Community HealthChoices Work With Medicare and Medicaid?

Understanding Medicare and Medicaid can be confusing, especially when someone has both.

Medicare is a federal health insurance program generally available to people age 65 and older and certain younger individuals with qualifying disabilities or conditions.

Medicaid, also called Medical Assistance in Pennsylvania, helps eligible people with health care costs and may cover long-term care services that Medicare generally does not provide.

For people enrolled in both programs, Community HealthChoices helps coordinate Medicaid benefits with Medicare coverage.

This can make it easier to understand which services are available and how different parts of a person's health care fit together.

PA Health & Wellness works with its network of health care providers and service professionals to help participants access covered care.

It is important to remember that having Medicare and Medicaid does not automatically mean someone qualifies for every long-term care service. Additional eligibility requirements and assessments may apply.

Helping Families Navigate Long-Term Care Decisions

When an older parent or loved one begins needing more help, families often have many questions.

Who can help Mom safely stay at home? Does Medicaid pay for home care in Pennsylvania? What happens if Dad needs more assistance after leaving the hospital? Where can we turn if a family caregiver can no longer provide all the help that is needed?

These are common concerns for families throughout Pittsburgh, Allegheny County, Beaver County, Butler County, Washington County, Westmoreland County and communities across Pennsylvania.

PA Health & Wellness Community HealthChoices can be an important resource for eligible individuals navigating these decisions.

Through health care coverage, care coordination and approved long-term services, the program helps participants and their families better understand available support.

Whether someone is planning ahead or facing an immediate change in care needs, learning about Community HealthChoices can be a useful first step.

How to Apply for PA Health & Wellness Community HealthChoices

If you believe you or a loved one may qualify for Community HealthChoices, Pennsylvania offers several ways to begin the application process.

Apply online: Visit Pennsylvania's COMPASS website at www.compass.state.pa.us to check eligibility and apply for benefits.

Apply in person: Contact your local County Assistance Office for help applying for Medicaid benefits.

Apply by mail: Complete a Pennsylvania Medical Assistance application and mail it to your County Assistance Office.

Need long-term care services? If you are seeking help with personal care, nursing home care or other long-term services, Pennsylvania's Independent Enrollment Broker can assist with the eligibility and assessment process.

Once eligibility is determined, individuals can review available Community HealthChoices health plans, including PA Health & Wellness.

Choosing the right plan is an important decision. Families should consider their doctors, available providers, covered benefits and individual care needs.

Why Consider PA Health & Wellness Community HealthChoices?

Finding the right care should not feel like solving a puzzle.

PA Health & Wellness works to help eligible Pennsylvanians understand their health benefits and connect with the services they need.

As a Community HealthChoices health plan serving Pennsylvania, PA Health & Wellness provides access to covered medical services and helps coordinate long-term support for participants who qualify.

For older adults, that may mean receiving assistance that makes daily living easier.

For individuals with disabilities, it may mean access to services that support greater independence.

For family caregivers, it may mean having additional resources and professional guidance when caring for someone they love.

Every person's situation is different. PA Health & Wellness focuses on helping participants understand their options and receive care based on their individual needs.

Learn More About PA Health & Wellness Community HealthChoices

If you or someone you love has both Medicare and Medicaid, needs assistance with daily activities or is exploring Medicaid long-term care options in Pennsylvania, Community HealthChoices may be worth learning more about.

PA Health & Wellness serves eligible Community HealthChoices participants throughout Pennsylvania.

To learn more about available benefits, eligibility and enrollment, visit www.pahealthwellness.com.

You can also contact PA Health & Wellness Participant Services at 1-844-626-6813 (TTY 711) for help understanding plan benefits and services.

PA Health & Wellness Community HealthChoices Helping eligible Pennsylvanians access health care, long-term support and services that promote independence and quality of life.

Coverage and services depend on individual eligibility, medical necessity, assessments and plan approval. Not all Community HealthChoices participants qualify for Long-Term Services and Supports.