Community Health Choices

What is Community Health Choices?

  • Is Pennsylvania’s mandatory managed care program for dually eligible individuals and individuals with physical disabilities – serving more people in communities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
  • CHC will improve services for hundreds of thousands of Pennsylvanians.
  • It is also a combination of Medicare and Medicaid.

What is Health Choices?

  • Is Pennsylvania’s mandatory managed care program for current Medical Assistance (Medicaid) participants.
  • Participants receive quality medical care and timely access to all appropriate physical and behavioral health services and/or drug alcohol services.

Understanding Community Health


Health Choices

  • Children up to, and including 20 years old.
  • Adults
  • Some women with breast and/or cervical cancer
  • Lawfully present immigrants might be eligible

Community Health Choices

  • Individuals ages 21 and older who are dually eligible for Medicare and Medicaid
  • Individuals ages 21 and older who need the level of care provided by a nursing facility
  • Individuals with intellectual or development disabilities who are enrolled in services through the Office of Developmental Programs and residents of a state – operated nursing facility (including state veteran’s homes) are not part of CHC.

What are the similarities between Community Health Choices and Health Choices?

  • Both are Medicaid managed care programs
    • Both programs utilize manages care organizations (MCOs) to provide coverage for their members.
    • The commonwealth pays the MCO’s a capitated monthly rate (like a premium for each member), and the MCOs coordinate the health care needs for their members.
  • Zones
    • Health choices and CHC use the same five geographic zones.
  • Choice
    • Members of both programs choose their MCO.
  • Physical health benefits
    • Health choices and CHC both offer the Adult Benefit Package for physical health services.
  • Behavioral health benefits
    • Both Health Choices and CHC-MCO are required to coordinate participants behavioral health services with the Behavioral Healthchoices MCO’s.

What are the differences between Health choices and Community Health choices?

Dual-eligible coverage

  • CHC provides coverage for participants who are eligible for both Medicare and Medicaid.
  • This means that CHC-MCOs will have to coordinate closely with Medicare to ensure that participants have access to comprehensive services.
  • Also CHC-MCOs will have the ability to provide Medicare coverage (called D-SNPs) to participants who would like their Medicaid and Medicare services coordinated by the same entity.
  • D-SNP’s Dual Eligible Special Need Plans

Long-Term Services and Supports (LTSS)

  • Community Health Choices
    • Provides LTSS to participants who need the level of care provided in a nursing home.
    • Participants who meet this criteria will receive LTSS and physical health services from their CHC-MCO, including nursing facility.
  • Health Choices MCOs
    • Will cover the first 30 days of nursing facility care. If a participant continues to need that level of care. the participant will apply for CHC.


  • Home health services
  • Hospice services
  • ICF/IID and ICF/ORC (requires an institutional level of care)
  • In patient hospital services
  • Labaratory services
  • Maternity (physician, certified nurse, midwives, birth centers)
  • Medical supplies


  • The following benefits are available to participants who are nursing facility clinically eligible and receive medicaid long-term services and supports through a home and community-based waiver or reside in a nursing facility. These are in addition to physical health benefits in the adult benefit package.
  • Home health – physical, occupational, and speech and language therapies
  • Specialized medical equipment and supplies