If you or a loved one are covered by Pennsylvania Medicaid, you’ve likely heard that the structure of care is changing. The state is in the process of implementing changes for Pennsylvania Medicaid that affect how and where your Medical Assistance services are received.
But how much do you know about the changes ahead and what they’ll mean for your family? Read on for a look at what the changes include and how they may impact you.
Making Sense of the Changes for Pennsylvania Medicaid
A few years back, the state of Pennsylvania decided to move toward a managed care system for its Medicaid program. Basically, what that means is that adults covered under Medicaid will be able to receive the medical services they need while continuing to live in their own homes.
The program, called Community HealthChoices, is moving forward toward implementation beginning early next year. In Southwest Pennsylvania, enrollment under the new program is taking place this year. Adults covered by Medicaid in Westmoreland, Washington, Fayette, Greene, Somerset, Cambria, Indiana, Blair, Bedford, Allegheny, Butler, Beaver, Lawrence, and Armstrong counties are required to choose a provider this year.
There are no additional costs for Community HealthChoices. You or your loved one will continue to have the same costs you pay today—and you’ll receive the same services.
What Will the Changes for Pennsylvania Medicaid Mean for My Loved One?
Under the Community HealthChoices program, adults who are on Pennsylvania Medicaid must enroll in either a local LIFE program, like Senior LIFE, or a managed care organization. Either of these two options will coordinate all medically necessary services for Medicaid enrollees.
If your loved one is currently receiving care through Aging Waiver, Attendant Care Waiver, CommCare Waiver, or Independence Waiver, you will need to choose one of the two options outlined above. If your loved one doesn’t choose one, one will be automatically assigned.
Community HealthChoices is mandatory for those on Medicaid who:
- Are age 21 and older
- Have physical disabilities
- Are dually eligible for Medicare and Medicaid
How Will I Know What Option to Choose for My Loved One?
The best option for your loved one and your family depends on a number of factors, including your loved one’s age and medical/personal care needs.
There are some important things to consider. While all programs under Community HealthChoices will be providing care designed to keep Medicaid recipients healthy and in the community, Senior LIFE has been offering these services to seniors in Pennsylvania for nearly two decades. Senior LIFE members and their caregivers can be confident that their care is backed by years of expertise.
Senior LIFE is an authorized option under Community HealthChoices and is available in 12 locations across Pennsylvania. Each location is designed to help seniors remain active, healthy, and independent enough to live within the community.
When members join Senior LIFE, they are assigned a team of providers that works with them to determine a plan of care that meets their individual needs. We’re proud to say that this team of providers both works and lives within the communities we serve.
After enrolling in Senior LIFE, members meet with a team of providers who put together an individualized plan of care. From there, members receive all medically necessary services in that plan of care through the program, including:
- Medical care
- Prescription medications
- Rehabilitation therapy
- Social activities
- Nutritional counseling
- Personal care services
- Access to an on-call nurse 24 hours a day, seven days a week
Is My Loved One Eligible for Senior LIFE?
To be eligible for Senior LIFE, a person must be age 55 or older, need assistance to remain the home, and be able to be safely served in the home. If you don’t think your loved one will be eligible, you might be surprised. Senior LIFE offers cost-free consultations that can determine eligibility and get your loved one started.
When it’s time to make a decision for the type of care your loved one will receive under Community HealthChoices, Senior LIFE may be an option. To learn more about the changes for Pennsylvania Medicaid or check Senior LIFE eligibility, visit www.seniorLIFEPA.com/locations to find the phone number for the location nearest to you.