region/plan-specific news : Pennsylvania HealthChoices

Community HealthChoices starts soon in southeastern Pennsylvania

Community HealthChoices (CHC) is Pennsylvania’s new mandatory managed care program for individuals who are dual-eligible, older adults and individuals with physical disabilities. Cambria County has been a part of the southwestern Pennsylvania implementation that started in January 2018, and Magellan staff continue to work closely with state and local officials to implement this new service.

In January 2019, Bucks, Delaware and Montgomery counties will be included in phase two of the statewide implementation for southeastern Pennsylvania. Magellan staff are preparing for this new service in coordination with our county partners, providers and community stakeholders.

Key features of Community HealthChoices:

• Individuals will be enrolled in CHC if they are 21 years old or over and are:
  • Receiving both Medicare and Medicaid
  • Receiving Medicaid long-term services and supports (LTSS) both in the community and a nursing home
  • 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
  • State blind and state blind pension recipients.
• CHC members living in a nursing facility with an aging waiver will have some change. Magellan will coordinate the behavioral health benefits of these members after they are enrolled in CHC. 

• This program will change the coordination of a CHC member’s physical health (PH) benefits.
  • Eligible members will select one PH-MCO (UPMC, AmeriHealth Caritas/Keystone First Community HealthChoices or PA Health and Wellness) to manage PH and LTSS.
  • Eligible members will have their behavioral health benefits coordinated by Magellan, and we will work closely with each PH-MCO to coordinate care.

For more information regarding CHC and to learn more about updates related to the status of the statewide implementation, please visit http://www.dhs.pa.gov/citizens/communityhealthchoices/.