PA Community HealthChoices

Community HealthChoices (CHC) is a crucial Medicaid waiver program in Pennsylvania, designed to enhance the lives of older Pennsylvanians and individuals with physical disabilities by offering them the option to continue residing in their homes. Managed by the Department of Human Services (DHS), this program provides long-term services and supports to eligible individuals, especially those who require assistance with daily personal tasks. The program also recognizes the indispensable role of family caregivers in the healthcare system and seeks to address their underpaid status by providing avenues for compensation.

Overview of Community HealthChoices

Community HealthChoices (CHC) is a transformative Medicaid waiver program implemented by the Pennsylvania Department of Human Services (DHS) to enhance the quality of life for older Pennsylvanians and individuals with physical disabilities. The program's primary goal is to empower eligible individuals to remain in their homes and communities rather than move into institutional settings.

CHC aims to achieve this by providing comprehensive long-term services and supports (LTSS) to individuals aged 21 and older with both Medicare and Medicaid or who require long-term support through Medicaid. These services are tailored to assist with various everyday personal tasks, including but not limited to dressing, bathing, and meal preparation.

The program's person-centered approach ensures that eligible individuals receive the necessary care and attention while promoting their independence and autonomy, fostering a supportive and compassionate environment for both care recipients and caregivers.

CHC was designed to integrate and streamline three former waiver programs: Aging Waiver, Attendant Care/Act 150 Waiver, and Independence Waiver.

Combination of Former Waiver Programs

The CHC is a newer program and combines three former waiver programs: Aging Waiver, Attendant Care/Act 150 Waiver, and Independence Waiver. Here's a brief overview of the three former waiver programs:

1. Aging Waiver: The Aging Waiver primarily targeted older adults aged 60 and above who required support with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The waiver covered services such as personal assistance, adult day care, home modifications, and more to help individuals age in place.
2. Attendant Care/Act 150 Waiver: The Attendant Care Waiver, also known as Act 150 Waiver, catered to adults with physical disabilities who needed assistance with ADLs and IADLs. It offered services like personal assistance, home health aide, respite care, and environmental adaptations to enable individuals to stay home.
3. Independence Waiver: The Independence Waiver was designed for individuals with physical disabilities under the age of 60. It provided services similar to those offered by the Attendant Care/Act 150 Waiver to help individuals with disabilities live independently in the community.

With the integration of these three waivers, CHC aimed to offer a comprehensive set of long-term services and supports to a broader population in Pennsylvania. The program focused on person-centered care, meaning the services were tailored to the individual's unique needs and preferences.

Eligibility Requirements for Community HealthChoices

Individuals must meet specific criteria to be eligible for Pennsylvania's Community HealthChoices (CHC) program. Here is a comprehensive list of the eligibility requirements:

1. Age: Applicants must be 21 years of age or older.
2. Residency: Individuals must be residents of Pennsylvania.
3. Citizenship or Immigration Status: Applicants should be U.S. citizens or qualified immigrants.
4. Medical Necessity: Individuals must require particular care and assistance with everyday tasks due to physical disabilities or chronic health conditions.
5. Medicaid and Medicare: Eligible individuals must either be dually enrolled in both Medicaid and Medicare or receive long-term support through Medicaid.
6. Functional Eligibility: Applicants' functional ability is assessed to determine their need for long-term services and support.
7. Financial Eligibility: There are income and asset limits that applicants must meet to qualify for the program. These limits may vary based on the individual's household size.
8. Level of Care Determination: Applicants must undergo a care assessment to determine the appropriate services and supports to meet their specific care requirements.

The eligibility process can be complex, and applicants may need assistance from caseworkers or support organizations to navigate through the requirements successfully. CHC is committed to helping eligible individuals access the necessary care and services to remain in their homes and communities while supporting family caregivers who play a vital role in this endeavor.

Services and Supports under Community HealthChoices

Community HealthChoices (CHC) offers a comprehensive range of services and support to eligible individuals to ensure they receive the care they need while remaining in their homes and communities. Here is an overview of the services and supports provided under CHC:

1. Home and Community-Based Services (HCBS) enable individuals to receive care in their homes or community settings, promoting independence and preventing unnecessary institutionalization. HCBS may include personal care assistance, adult day services, home modifications, and respite care.
2. Specialized Healthcare Services: CHC covers a range of specialized healthcare services, including skilled nursing care, therapies (physical, occupational, and speech), and behavioral health services. These services address the unique healthcare needs of eligible individuals.
3. Assistive Technologies: The program offers assistive devices and technologies to enhance individuals' abilities and support their daily living, which may include mobility aids, communication devices, and home medical equipment.
4. Community Transition Services: CHC supports individuals transitioning from institutional settings to their homes or community-based living, including care coordination and assistance with the transition process.
5. Participant-Directed Services: Under certain circumstances, eligible individuals may have the option to self-direct their care, giving them greater control and flexibility in choosing their caregivers and services.
6. Care Coordination: Each participant in the program is assigned a care coordinator who assesses their needs, develops a person-centered care plan, and coordinates services and supports to ensure comprehensive and effective care.
7. Nursing Facility Services: CHC covers services for individuals in nursing facilities who meet the program's eligibility requirements.
8. Behavioral Support Services: These services address behavioral challenges and support individuals in managing their emotional and psychological well-being.

CHC's commitment to providing various services and supports enables eligible individuals to lead fulfilling lives while receiving care tailored to their unique circumstances. The program promotes independence, dignity, and a higher quality of life for care recipients and their dedicated family caregivers by emphasizing home and community-based care, offering specialized healthcare services, and incorporating assistive technologies.

Compensation for Caregivers under Community HealthChoices

Yes, the Community HealthChoices (CHC) program in Pennsylvania recognizes the crucial role of unpaid family caregivers and offers avenues for compensation for their valuable services. Through CHC, eligible individuals can select their family members as paid caregivers, allowing them to receive financial reimbursement for their caregiving efforts.

To access compensation, family caregivers must follow the following process:

1. Caregiver Selection: The care recipient eligible for CHC services can choose a family member as their caregiver. This selection is based on mutual agreement and the caregiver's willingness to provide the necessary care.
2. Assessment and Approval: The selected family caregiver undergoes an evaluation to determine their qualifications and ability to meet the care recipient's needs. If approved, the caregiver can begin providing care.
3. Care Plan Development: A person-centered care plan is developed in collaboration with the care recipient and the approved caregiver. This plan outlines the specific care services and supports required.
4. Compensation Process: Once the care plan is in place, the approved family caregiver can begin providing the designated care services. They are compensated for their caregiving role based on an agreed-upon payment rate.
5. Documentation and Reporting: Caregivers must maintain accurate records of the care services they provide, including dates, times, and tasks performed. These records are essential for reporting and documentation purposes.
6. Payment Processing: Compensation for family caregivers is typically processed through the state's Medicaid system. The specific procedures and payment schedule may vary depending on the state's guidelines.

Family caregivers must stay informed about the reporting procedures and comply with any documentation requirements to ensure they receive fair compensation for their dedicated caregiving services. CHC's recognition and support of family caregivers aim to alleviate the financial burden and acknowledge the immense contributions they make to the well-being of their loved ones and the overall healthcare system.

Limitations and challenges

While Pennsylvania's Community HealthChoices (CHC) program offers significant support to eligible individuals and their family caregivers, it may still face some limitations and challenges. One potential challenge is the complexity of the eligibility and application process, which could deter some individuals from accessing the program's benefits. Additionally, funding constraints or changes in Medicaid policies could impact the availability and scope of services, potentially affecting the quality of care. Addressing these limitations and ensuring streamlined access to services remain essential for the program's continued success in supporting older Pennsylvanians and individuals with physical disabilities.

A Note from Givers

If you believe you may qualify for compensation under CHC, don't hesitate to fill out this form to determine your eligibility and access the support you deserve. Your dedication deserves to be acknowledged, and we are here to stand with you every step of the way.