By Kristin Daugherty, Long-Term Care Planner, Certified Medicaid Planner™, Certified Dementia Practioner®

Let’s face it, not many of us deal well with change. If you are like me, I always jump right to the negative aspects of the upcoming change and start to panic. So, when Pennsylvania announced that they were converting to a new long-term care Medicaid program, I instantly thought about how this change could affect people and their medical services.

If you have spent any amount of time with me, you know I am passionate about my job and helping everyone who comes into our office. This is the reason that I have devoted a great deal of time to learning about the recent changes to long-term care Medicaid. Through webinars, seminars, and phone calls with counties that were first enrolled in Community Health Choices (CHC), I have been able to learn about the good, the bad, and the ugly of CHC. Here is what you need to know.

CHC is a managed care program that will insure all Pennsylvania residents who are “dual eligible” (eligible for both Medicare and Medicaid) and need services in a nursing home or through the Office of Long-Term Living (OLTL). All dual eligible recipients must enroll in CHC with one of the three health plans that are contracted through the State of Pennsylvania; UPMC CHC, PA Health & Wellness, and Keystone First (aka AmeriHealth). Each of these health care plans contract with nursing homes, in-home care providers, and primary care physicians to meet your health care needs.

Sounds simple, right? Well, here is one of the biggest changes with CHC. If you are a resident at Happy Nursing Home and enroll with PA Health & Wellness, they need to have a contract for you to continue to reside at Happy Nursing Home. Now, that doesn’t mean that you must leave that nursing home, but you will need to change health care plans, which you can do at any time. Thankfully in our area, it seems that so far each health care provider is contracting with every facility.

The application process for Medicaid recipients residing in-home can be long and tedious. It can take up to 3-5 months to start in-home care services and you are dealing with multiple agencies. For those who need help today, it is hard to wait that amount of time for services to start. Unfortunately, this process is not getting any easier with CHC. The State is pushing for stricter deadlines for enrollment, although in discussions with others in the State who started CHC already and from experience, the biggest concerns are the decrease of hours for in-home care and the push for families to step in and help more. Yikes! This sounds like it could be extremely difficult for many families.

For those of you that have a loved one enrolling in the CHC program for in-home or nursing home care, the best advice I can give you is to do your homework. Be an advocate and make sure you understand and are comfortable with what you are being told. If you are unhappy with your managed care provider, you have the right to switch at any time. Know your rights and be an advocate!
For additional information on CHC, you can visit its website.