State College, PA - Centre County - Central Pennsylvania - Home of Penn State University

New managed care program to debut in 2020

by on July 25, 2019 9:54 AM

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 longterm care Medicaid program, I instantly thought about how this change could affect people and their medical services.

Through webinars, seminars, and phone calls with counties that are already under 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, it needs 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 (although I have a feeling that it is not as easy as the State says that it will be).

We do not know exactly which health care plans are contracting with which providers yet, but these contracts should be set up in the near future.

The application process for Medicaid recipients residing in-home can be long and tedious. It can take up to three to five 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, I do not see this process 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, 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. I could go on and on about CHC and the changes that will start on January 1, 2020. All longterm care Medicaid recipients will start receiving letters and phone calls in July 2019.

Additionally, the OLTL will be hosting numerous sessions in our region to inform Medicaid recipients and their families about the upcoming changes. I encourage you to take advantage of the opportunity to attend these sessions which will be outlined in correspondence that will be arriving in your mail soon.

For additional information on CHC, you can visit the website at www.healthchoices.pa.gov.

Steinbacher, Goodall & Yurchak is an elder care and special needs law firm offering quality representation to clients throughout Pennsylvania. Since its beginning, the firm has dedicated itself to practicing law with extraordinary standards of ethics and values. The vision of the firm has been to provide individuals and their families with a unique plan to protect their assets for their spouses and future generations, while providing for their immediate and long-term needs.

To schedule your appointment, call (800) 351-8334 in the Lycoming and Centre County communities.

Kristin Daugherty is a long-term care planner and certified Medicaid planner.

 

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