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. The CHC program was designed to:
- 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?
- Those on Medicare and Medicaid
- Those in Medicaid Nursing homes
- Those with waiver services
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 program for people who qualify, the state will send you information on how to enroll and choose your MCO. If you missed the package sent out you can check on your enrollment at http://enrollchc.com LINK it. If you Did not pick an MCO yourself and you are eligible 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 PCP is taking your Medicare Plan, but your MCO is different than your PCP’s
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 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)
I lost my CHC card and know my MCO?
AmeriHealth Caritas Pennsylvania (Southwest zone)
1-855-235-5115 (TTY: 1-855-235-5112)
Keystone First (Southeast zone)
1-855-332-0729 (TTY: 1-855-235-4976)
Pennsylvania Health & Wellness
1-844-626-6813 (TTY: 1-844-349-8916)
UPMC Community HealthChoices
1-844-833-0523 (TTY: 1-866-407-8762)
I lost my card and DO NOT know my MCO provider?
Order through the automated system. The number is 1-844-824-3655. Have your last 4 of SSN, DOB, & confirm their address.
I received a bill from my Dr?
Confirm the provider is accepting CHC and contracted with the same MCO as you.
Check provider here https://www.enrollchc.com/choose/find-provider
My Dr. is not accepting CHC
Unless you are willing to pay out of pocket you may need to switch to a participating Doctor to have services covered.
How can I switch MCOs?
How can I switch my Medicare Plan to coordinate with my MCO?
It is best to speak with a professional with access to the various carriers provider searches and other tools to assist with matching providers and programs. As a Medicare and Medicaid beneficiary you have plans available to you to further enhance your healthcare experience and enrollment opportunities to make plan changes.
How can I get help with this?
Give us a call at 844 611 9376 or Schedule a benefits review and we can help you coordinate the best coverage option for your individual needs.