Pennsylvania Announces Selection for Community HealthChoices Managed Care Agreements

The Department of Human Services (DHS) continues to improve access to high-quality services and serve more people in the community.

Harrisburg, PA – Today, the departments of Human Services (DHS) and Aging announced that the commonwealth has agreed to move forward and negotiate agreements with three managed care organizations (MCOs) for Community HealthChoices (CHC).

CHC will coordinate physical health and long-term services and supports (LTSS), if needed, to enhance the quality of medical care and access to all appropriate services to more than 420,000 individuals who are dually eligible for Medicare and Medicaid, older Pennsylvanians and individuals with disabilities.

“We are committed to increasing opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. CHC allows us to serve more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life,” said DHS Secretary Ted Dallas. “The MCOs selected today will provide a choice of health care and LTSS providers to everyone moving into CHC and allow them to receive the services they need in a coordinated manner.”

Through a request for proposals, DHS has selected the MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in 2017. The following MCOs were selected for negotiations on a statewide basis:

  • AmeriHealth Caritas
  • Pennsylvania Health and Wellness (Centene)
  • UPMC for You

“Like many states across the country, the opportunity for Pennsylvania to further strengthen the social safety net, which is anchored by Medicare and Medicaid, by transitioning to a managed long-term services and supports model takes a major step forward today via this announcement,” said Secretary of Aging Teresa Osborne. “Eligible older Pennsylvanians and persons with physical disabilities are relying upon the departments of Aging and Human Services to ensure that this transition is seamless, and our proceeding in dialogue with these managed care organizations demonstrates the Wolf Administration’s commitment to ensuring that Pennsylvanians can access necessary services and supports in order to age in place.”

The MCO agreements will also continue the departments’ increased focus on greater coordination between the physical and behavioral health systems, as well as LTSS. CHC will:

  • Enhance opportunities for community-based services and increase access to services;
  • Strengthen health care and LTSS delivery systems;
  • Allow for new innovations;
  • Promote the health, safety, and well-being of enrolled participants; and
  • Ensure transparency, accountability, effectiveness, and efficiency of the program.

CHC will roll out in three phases. Persons eligible for CHC are 21 or older who have both Medicare and Medicaid, or who receive long-term services and supports through Medicaid because they need help with everyday activities of daily living.

The departments have created an overview of the program that can be seen here.

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