Medicare

is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-stage Renal Disease (Permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD. – urology supplies.

Medicaid

In the United States is a social health care program for families and individuals with limited resources. The Health Insurance Association of America describes Medicaid as “Government insurance program for persons of all ages whose income and resources are insufficient to pay for health care”.

Attendant Care Waiver

-Meet the level of care needs for the Skilled Nursing Facility.

  • Be between eighteen (18) and fifty-nine (59) years of age.
  • Be capable of a.) Hiring, firing and supervising attendant care worker(s); b.) managing your own financial affairs; and c.) managing your own legal affairs

Independence Waiver

  • Be 18-60 individuals that turn 60 while in the waiver will be able to continue to receive services through the independence Waiver.
  • Individuals who are physically disables (but not individuals with an intellectual disability or have a major mental disorder as a primary diagnosis, or who are ventilator dependant), who reside in a Nursing Facility (NF) or the community bur who have been assessed to require services at the level of nursing facility level of care.
  • In addition, the disability must result in substantial functional limitations in three or more of the following major life activities.
  • Self-care, understanding and use of language, learning, mobility, self-direction and/or capacity for independent living.

Comm-Care Waiver

To eligible for the COMMCARE Waiver you must:

  • Be a Pennsylvania resident.
  • Be 21 years of age or older.
  • Have a mesically determinable diagnosis of traumatic brain injury and require a Nursing Facility (NF) level of care.
  • Meet the financial requirement as determined by your local County Assistance Office.

OBRA Waiver

  • Have a severe development physical disability requiring an intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care.
  • The disability must result in substantial functional limitations in three or more of the following major life activities: self-care, communication, learning, mobility, self-direction and capacity for independent living.

Managed LTSS

Managed Long Term Services and Supports (MLTSS) refers ti the delivery of long term services and supports through capitated Medicaid managed care programs. Increasing numbers of states are using MLTSS as a strategy for expanding home- and community-based services, prompting community inclusion, ensuring quality and increasing efficiency.

PENNSYLVANIA HC AND CHC

  • Health Choices MCO
    • Aetna Better Health
    • AmeriHealth (caritas) (northeast)
    • Gateway Health Plan
    • Gesinger Health Plan
    • Keystone First
    • PA Health & Wellness
    • UPMC for you
    • United HealthCare
  • Community Health Choices
    • Amerihealth
    • PA Health & Wellness
    • UPMC Community Healthchoices
CHC Equation Medicare Medicaid = CHC Wavier = CHC Example : Gateway Medicare Assured (KEEP) = CHC Keystone First (HAVE TO CHANGE
SINCE MEDICAID)