The Community Health Choices (CHC) is a program model in which Managed Care Organizations (MCO) are responsible for the delivery and pay of client services instead of the state. A Managed care Organization (MCO) has been effective since January 2019. An MCO is a delivery system organized to manage cost, quality and utilization of services the client receives. The MCO’s are reimbursed by the state to provide services to the clients.
The Managed Care Organizations you may be familiar with include insurance companies such as: Keystone First CHC, UPMC, and PA Health &Wellness. These insurance companies receive payment from the state not only because it is cheaper but also because they are able to manage utilization and quality of health services the clients receives.
Managed Care is a health care delivery system organized to manage cost, utilization, and quality
Community Health Choices (CHC) is the state having insurance companies (managed care entities) pay for your care instead of the state paying for your care directly.
CHC is a mandatory program for people who are age 21 or older and qualify for:
To learn about who can enroll in the program, go to Who qualifies for CHC?
CHC covers the same physical health benefits you have now in your Medicaid Adult Benefit Package. With CHC, all of your Medicaid and prescription drug benefits are in one health plan. To see a list of services covered by all plans, go to Physical and behavioral health benefits.
If you receive LTSS, you will now get those services and supports through your CHC health plan. To see a list of LTSS covered by all plans, go to Long-term services and supports.
All health plans have care coordination to manage your health care. To learn more, go to Care coordination.
You will choose a health plan and primary care practitioner (PCP).
Use this website to help you choose the best health plan and PCP for you
Please note: If you have Medicare and Medicaid and are enrolled in a Medicare Advantage plan, you will not have to change your Medicare PCP.
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