Community Health Choices

About Community Health Choices

Community HealthChoices (CHC) is Pennsylvanias mandatory managed care program for individuals enrolled in Med- icaid for Long Term Services and Supports, Medicaid-eligible older adults and individuals with physical disabilities, and Medicaid-eligible consumers who reside in a nursing home. It is administered by the Pennsylvania Department of Human Services Office of Long Term Living and provided statewide by three managed care or insurance companies. It offers coordination of medical and social supports for participants. Community HealthChoices provides choice, control, and access to a full array of quality services that provide independence, health, and quality of life for participants.

Services will include the standard Medicaid adult benefit package in addition to all long-term services and supports a person may need to remain healthy at home or in a long-term care facility. Services may include:

Doctors visits

Prescription drugs

In-home care

Durable medical equipment (supplies)

Transportation

CHC eligibility requirements

Individuals can enroll in CHC if they:

are 21 years old or older. 

are eligible for Medicaid.

qualify for Medicaid with an assessed and documented need for long-term services and support.

Individuals with intellectual or developmental disabilities who are eligible for services through the Office of Developmental Programs and residents of a state-operated nursing facility (including state veterans homes) are not part of CHC.

How does CHC work?

Each CHC participant needing long-term care will have the support and assistance of a service coordinator to access needed services. Service coordinators identify, coordinate, and assist participants in obtaining access to needed health services and in-home supports, as well as social and housing services needed to help participants live in their communities. Under CHC, a service coordinator is a managed care organizations designated, accountable point-of-contact for each participant.

Service coordinators can:

develop and update a person-centered service plan.

assist CHC participants in obtaining and coordinating the services that they need, including, for example, long-term care services, community services, family support, physical health, behavioral health, support for caregivers, social and housing services, and discharge planning.

guide participants through challenges that might limit their independence, including returning home.

provide choices for what service is provided, when the service is provided, and who provides it.

regularly assess and re-assess participant needs.

Eligibility & How to Apply:

Individuals WILL be enrolled in CHC if they are 21 years old or over and are:

• Receiving both Medicare and Medicaid
• Receiving long-term services and supports in the Attendant Care, Independence, COMMCARE, or Aging waivers
• Receiving services in the OBRA waiver AND determined nursing facility clinically eligible
• Receiving care in a nursing home paid for by Medicaid
• An Act 150 participant who is dually eligible for Medicare and Medicaid
• 
  

Individuals are NOT eligible for CHC if they are:

• Receiving long-term services and supports in the OBRA waiver and are NOT nursing facility clinically eligible
• An Act 150 program participant, who is not dually eligible for Medicare and Medicaid
• A person with an intellectual or developmental disability who is receiving services through the DHS' Office of Developmental Programs
• A resident in a state-operated nursing facility, including the state veterans' homes 

Here is a comprehensive checklist of items to include when applying for CHC Waiver, Nursing Home Transition and the OPTIONS/Family Caregiver Support Program. These items need to be provided to the assessor for eligibility. If they are not, it could slow down the process when applying for various services.

Provide photocopies of the following:

proof of date of birth, birth certificate, baptismal certificate or drivers license

Social Security card

health insurance cards

proof of gross income (often participant and spouse) Social Security, pension, R.R., VA, etc.

burial funds

life insurance

bank accounts and liquid assets

property deeds

power of attorney or guardian papers

Visit https://www.compass.dhs.pa.gov/home/#/ to apply and to learn more.