Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals who are dually eligible for Medicare and Medicaid, and individuals 21 years of age or older with physical disabilities who receive long-term services and supports through Medicaid. CHC is currently live in the Southwest and Southeast part of the state. The remainder of the state will transition to CHC on January 1, 2020.
CHC participants have protections if they do not agree with a CHC managed care organization’s (CHC-MCO’s) decision to deny, decrease, or approve a service or item different from what was requested. Participants can also voice dissatisfaction with their CHC-MCO or a provider. These concerns or issues can be voiced through the complaints and grievance process. Information about the complaint and grievance process is available in this fact sheet. Additional information is provided in a comprehensive FAQ Document. For additional questions, please visit the CHC website or submit via email.
The Office of Long-Term Living (OLTL) recently issued a notice to share that Community HealthChoices (CHC) pre-transition notices were being sent this week to individuals eligible for CHC in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. If members receive questions from eligible enrollees, they should encourage them to visit the HealthChoices website for more details or to enroll in information sessions. Please note that information sessions are intended for potential enrollees, and providers may attend only if they are not taking a spot from a potential enrollee. A copy of the notices and all CHC participant communications are available online.
OLTL also issued a CHC Complaints and Grievances Fact Sheet. CHC offers protections for participants who disagree with a CHC managed care organization (CHC-MCO) decision to deny or decrease a service or approve a service or item that differs from what was requested. Participants also have protections if they are dissatisfied with their CHC-MCO.
Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.