Pennsylvanians Should Know: The Move To CHC-MCO
For Pennsylvanians currently receiving care through Medicaid waiver-based services, it’s important to be aware of the state’s gradual transition from all waivers to a new, mandatory managed care program called Community HealthChoices – Managed Care Organization (CHC-MCO). Community HealthChoices is a long-term services and supports program designed to roll all services — health care, behavioral health care, long-term services and supports — into one extensive plan managed and coordinated by Managed Care Organizations (MCOs).
What is the goal behind the CHC-MCO transition?
The plan’s goals are twofold:
- Increase access and improve coordination of medical care by making sure all services – Medicare, Medicaid, Behavioral Health, LTSS – work better together.
- Establish a long-term support system where people have agency when it comes to their care: choice, control, and access to many services that increase their quality of life, independence, and health situation.
What does this mean for my care with OSH?
You will not lose your care, and Open Systems Healthcare will continue delivering services as usual. Contact us at 855-616-2662 if you have further questions.
What are the Managed Care Organizations (MCOs) managing Community HealthChoices (CHC)?
As part of the transition, Pennsylvania’s Department of Human Services selected three MCOs to manage Community HealthChoices health plans. They are Amerihealth Caritas, PA Health & Wellness, and UPMC. Instead of receiving your Medicaid benefits from the state, your benefits will come through a plan managed by one of these organizations that you can choose.
When does the CHC-MCO transition go into effect?
The transition to the CHC-MCO plan is in three installments targeting regions in PA:
- Southwestern PA began its transition in January 2018
- Southeastern PA began its transition in July 2018
- Northeastern PA, Northwest PA, and the Lehigh/Capital region will transition starting January 2019
Who is eligible for the Community HealthChoices (CHC) program?
Those who are eligible for Community HealthChoices (CHC) are Pennsylvanians 21 or older and are either:
- Qualified for both Medicare and Medicaid
- Receiving long-term services and supports (LTSS)
You do not need to be currently receiving waiver-based services in order to qualify for the CHC program.
Please note that Community HealthChoices only affects your Medicaid benefits, not your Medicare. If you are covered by Medicare as your main insurance, you can expect to keep the same plan and doctors. CHC only covers the Medicaid portion of your benefits and will cover anything that Medicare does not.
How am I involved in the transition?
If you are eligible for the CHC-MCO program, you will be notified by Pennsylvania’s Department of Human Services at least 90 days before the Community HealthChoices (CHC) transition begins in your region. PA’s Department of Human Services will provide you with all relevant information and how to enroll in a CHC-MCO plan. You will be able to choose your own CHC-MCO provider and plan. This program is mandatory — if you do not choose a CHC-MCO plan, a plan will be assigned to you moving forward.
Participants enrolled in a new CHC-MCO plan will continue to receive care from their current services for 60 days. Within this time, you will work with your service coordinators or CHC-MCO to choose specific providers for your care plan.
You can change your CHC-MCO at any time through two ways:
- Contact PA’s Independent Enrollment Broker (IEB) at 1-844-824-3655
- Visit www.enrollchc.com to enroll or switch plans
Who should I contact if I have more questions?
Speak with your Service Coordinator or contact the CHC Participants helpline at 833-735-4416.