Starting in January 2017, residents of southwest Pennsylvania will become eligible for the brand new Community Health Choices (CHC) program administered through the Department of Human Services (DHS). Participants who enroll in the program will begin to receive benefits in July of 2017. The CHC will allow participants to receive care and long-term services and support in the comfort of their own communities, and bolster the patient-centered healthcare initiative from Governor Wolf.
Why CHC?
Many patients are eligible for both Medicare and Medicaid and they are often dually enrolled. These patients’ healthcare and long-term services and supports (LTSS) have, in the past, been handled by separate agencies. CHC will pull the management of those patients’ care into one managed care organization so that they receive the best quality care; because all of the records are in one place, no needed treatments fall through the cracks and the patients are cared for in their own communities.
Who Qualifies?
The CHC will automatically enroll anyone who is over the age of 21 and:
- Requires full-time nursing care; OR
- Lives in a community where home care based services, like those from Neighborly Home Care, are available; OR
- Qualifies for both Medicare and Medicaid
Residents are excluded from the program if they participate in the Act 150 program, qualify for assistance through the DHS Office of Developmental Programs, or currently live in a state-operated nursing home.
The state estimates the program will cover more than 420,000 individuals at a cost of $7.1 billion, with nearly 100,000 participants getting home care in Delaware County.
What Does CHC Do?
The CHC program is designed to improve the quality of medical care for qualifying members by expanding their care options and granting participants more control over their medical care. When participants enter the program, they choose from available LTSS contractors in order to receive the level of care desired. For instance, a participant may choose a company like Neighborly Home Care to provide light housekeeping assistance or transportation services to make medical appointments in Delaware County.
By bringing many of the services participants need into their homes, the CHC empowers participants to enjoy a greater degree of freedom and independence than previously experienced. Participants are able to spend time in their communities, so they may continue to work and increase the time that they can spend with family and peacefully age in place.
Enrollment Process
The enrollment process is straightforward for qualifying participants. Eligible residents may contact an enrollment assistant to discuss possible choices. Participants choose from a list of managed care organizations, such as: Aetna, Cigna-Health, Gateway Health Plan, United Healthcare and more.
The enrollment counselor will work with enrollees to ensure their choice meets their specific medical needs for home care in Delaware County. Participants who are unsure about which option is best may allow the counselor to make the decision.
The community support option improves the quality of life for CHC participants by allowing them to stay in a familiar environment instead of being forced into a managed care facility. Though the initial program is only in southwest Pennsylvania, the state expects an expansion of the program quickly.
Contact Neighborly Home Care today for further information about home care options and other professional services and care.