Community HealthChoices (CHC) is Pennsylvania’s managed long-term services and supports program for eligible adults who need ongoing assistance. It is designed to coordinate health care and long-term supports so eligible individuals can receive services in their homes and communities when appropriate. CHC generally serves adults age 21 and older who meet the program’s Medicaid, Medicare, disability, or long-term-services eligibility requirements. The program uses assessments and individualized service planning to determine the supports a participant needs.
For someone who has difficulty with everyday activities, the process begins with determining eligibility and the level of care needed. Once enrolled, the participant’s needs, preferences, safety concerns, and available supports are considered when services are planned.
Who May Qualify for CHC?
CHC has specific financial, clinical, and program requirements, so meeting one condition alone does not guarantee enrollment. Common eligibility considerations include:
- Being a Pennsylvania resident and generally age 21 or older.
- Being enrolled in Pennsylvania Medical Assistance when seeking CHC through Medicaid eligibility.
- Being eligible for both Medicare and Medicaid, or qualifying for Medicaid long-term services and supports.
- Meeting the applicable clinical or nursing-facility level-of-care requirements when seeking long-term services and supports.
- Not falling within categories excluded from CHC, such as certain individuals receiving long-term supports through Pennsylvania’s Office of Developmental Programs.
What CHC May Include
Available supports depend on the participant’s eligibility, assessment, and authorized service plan rather than automatically applying to everyone. Depending on the participant’s circumstances, the program may include:
- Personal assistance services: Support with approved everyday personal activities and routines.
- Respite services: Temporary support intended to provide relief for an unpaid caregiver when authorized.
- Home and community-based supports: Assistance designed to help eligible participants remain in community settings rather than institutional care.
- Transportation-related supports: Certain transportation services may be available when included and authorized under the participant’s plan.
- Service coordination: Help coordinating services, communicating needs, and maintaining the participant-centered service plan.
How to Begin the CHC Process
The enrollment process involves eligibility review, assessment, and service planning rather than simply selecting a home care provider. If you believe CHC may be appropriate, the general process is:
Step 1
Contact your local County Assistance Office or the Pennsylvania Independent Enrollment Broker to discuss long-term services and supports.
Step 2
Complete the required Medical Assistance and program eligibility process, including requested financial information.
Step 3
Complete the appropriate functional or clinical assessment to determine whether you meet the applicable level-of-care requirements.
Step 4
Work with the appropriate enrollment and care-planning representatives to identify your needs, preferences, risks, and available supports.
Step 5
Review the resulting service plan and, once services are authorized, work with approved providers that can deliver the services included in the plan.