CHC Community HealthChoices MCO Approved Providers List

senior home health assistance services for caregiving in philadelphia

CHC Community HealthChoices MCO Approved Providers List

Are you looking for a search tool and list of approved providers that accept the Community HealthChoices Medicaid waiver in Pennsylvania? From home care agencies to doctors, we’ve created a guide for you to look them up and find them all here with CHC healthcare plan providers with UPMC, Keystone First, and PA Health and Wellness insurance.

Perhaps you are new to the PA Medicaid waiver program or to Home and Community Based Services (HCBS) and looking for providers that accept your insurance. You also may simply be evaluating the different managed care plans under the Community HealthChoices waiver to see which one might work with the providers you care about. 

Whether you have or are considering the managed care plans under Amerihealth Caritas’ Keystone First, UPMC, or PA Health and Wellness, see our direct links that take you to the search tool to find the list of approved providers under a wide variety of services. We include links to all of their network providers, including for doctors, pharmacy, and for services specific to Home and Community Based Services. Through out tool, you can easily search and browse a variety of eligible providers of healthcare and other services right here. 

Plus, we help you break down what Community HealthChoices is, what the Medicaid waiver is, and getting signed up for services if you aren’t yet enrolled. 

What is Community HealthChoices, or CHC?

Community HealthChoices

Community HealthChoices is a state Medicaid program. It’s a part of Pennsylvania’s Medicaid waiver. The program allows companies, called managed care organizations (MCOs), to coordinate medical care and long-term services and supports (LTSS) for its participants. The providers are also contracted to provide Home and Community Based Services across the state of Pennsylvania.

What is the goal of the CHC waiver?

The CHC waiver program as it relates to Home and Community Based Services has one overall aim: to keep seniors and adults with disabilities residing safely and comfortable in their own home. This is a win-win situation for everyone involved. Most people, including their families, want to reside in their own home and in their communities for as long as possible. Plus, providing the right mix of services and supports in the community is often cheaper than institutional care, such as a nursing home

What does Community HealthChoices do and how does it keep seniors and disabled adults living in their own homes?

CHC directs care and services for people that qualify for Medical Assistance and Medicare and who also require a certain level of care. The level of care is referred to as Nursing Facility Clinical Eligible (NFCE). Basically, it is a way to classify individuals that are determined to have a medical need that would require a level of care of a nursing home. It keeps people in their own home through personalized assessments and setting them up with a mix of services that are designed to let people stay in the community. For example, a participant may get an evaluation by the health plan and be approved for services such as home care, home delivered meals, or personal emergency response systems (PERS). Again, the overall goal is to keep these members in their own homes or the community as long as it is safe to do so and to maintain quality of life.

How can I qualify to stay in my home when I am required to show that I need care that is equal that offered in a nursing home?

Pennsylvania's CHC Medicaid Waiver for home and community based services

Participants, like disabled adults and seniors, must show clinical needs that equal care offered in a nursing home to be eligible.

 

Good question. Just because one might need support and healthcare services that equal the level of that offered in a nursing home does not mean one can get support in the home. Again, through formal caregiver services, other supports offered, and also factoring in family caregiving, one can easily get a “nursing home level of care” in their own residence.

Who can enroll in Community HealthChoices?

Community HealthChoices participants approved to enroll in a Medicaid health plan include:

  • Pennsylvanians and individuals who are 21 or older, and have both Medicare and Medicaid. Alternatively, it includes individuals that receive long-term supports through Medicaid but who need help with everyday personal tasks and activities of daily life.
  • CHC will coordinate long-term healthcare coverage. The ultimate goal is to improve the quality of the person’s healthcare experience. CHC strives to serve more people in communities as opposed to healthcare facilities. The program is designed to give eligible adults the chance to spend more time with their families, an opportunity to work,, and experience an improved quality of life.

 

Why are there three different health plans in the CHC waiver program? 

Medicaid waiver keystone first UPMC pa health and wellness

HCBS through the Medicaid waiver can select Amerihealth Caritas (AKA Keystone First), UPMC, or PA Health and Wellness.

 

There are several different health plans that participate in the CHC waiver program. Overall, there are three insurance plans with Community HealthChoices to provide options and choice to eligible members. 

While the health plans offer many of the same services and benefits, there are some ways that they are different. For example, some may have enhanced coverage in different areas or have lower co-pays with certain services provided. Plus, as with any company, there may be differences in the level of service provided, or in getting approvals and adjustments, for example. The quality of businesses will vary and healthcare plans in CHC Medicaid waiver are no exception.

What are the three different health plans offered under the Community HealthChoices waiver?

As we discussed, three healthcare plans, also known as managed care plans, or MCOS, are contracted to provide Home and Community Based Services under CHC Medicaid waiver. They include the following insurance plans:

I’ve heard of AmeriHealth Caritas. Is that the same thing as Keystone First?

Yes and no. Keystone First is the name of the Community HealthChoices waiver plan in the Philadelphia, Pennsylvania region. AmeriHealth Caritas is the same insurance plan but serves the rest of the state of Pennsylvania. Therefore, they are the same plans but Keystone First is the CHC insurance provider for AmeriHealth Caritas in greater Philadelphia. 

What are the different services available with the CHC waiver providers at UPMC, Keystone First, and PA Health and Wellness?

Medicaid waiver keystone first UPMC pa health and wellness

There are numerous services that might be available. In total, there are 19 standard benefit services that are a part of the CHC healthcare plan service offerings. We list each of them with an explanation of each service in our article Pennsylvania’s CHC Medicaid Waiver: A Guide to Services at Home. You will find the article very beneficial to help you both understand what services are available and what each of them mean. Some individual health plans may have additional benefits or perks available. 

Does that mean I can get all of the services listed if I am approved for the CHC waiver?

No. You will have to go through several assessments to determine your needs and what services and supports you need to thrive in the community. For example, some individuals approved may only have one service offered as part of their care plan. As a side note, most individuals do qualify for home care support in the CHC waiver program

This is because many of the seniors and disabled adults that are approved into the program do in fact need help with activities of daily living (ADLs). However, everyone is unique and has their own needs and supports required. The services you ultimately are approved for will be spelled out in detail in your client care plan. 

Approved providers with each CHC Medicaid waiver health plan

We’ve broken down the provider searches to make it as easy as possible for your searches. Many are done with just one click! For one-click options, please note that we default our location to Philadelphia, PA. You can easily adjust your location if you are in other parts of the state if you need to. 

Pennsylvania's CHC Medicaid Waiver providers

Keystone First

Main search and landing page for provider searches

Home Care Agencies: Keep in mind that Chosen Family Home Care is also a proud home care partner of Keystone First. Chosen Family Home Care is an excellent home care provider proudly serving the Philadelphia region


Find these related topics in home care and waiver services to help you:


Hospitals: Discover in network hospitals that accept Keystone First health plan.

Labs: Find in network laboratory service providers

Doctors by specialty: When you reach the page, just begin to search for the Keystone First doctors by their specialty or focus. For example, you can begin to type “dementia” for dementia care providers or “cardiology” for heart physicians.

Doctors by name: Have a particular doctor in mind? You can search your doctor by their own name. 

PA Health and Wellness

chc providers with keystone first

Main search and landing page for finding PA Health and Wellness participating providers

Long term services and supports: This is for the Home and Community Based Services that an individual can receive in the community. Just click on the HCBS link and then select the specialty. Here, you can see a variety of options relevant to services at home through the Medicaid waiver. For example, you’ll find information on adult day care centers, in home supportive care, home health aides, or minor home modifications. 

Home care services: Click the link to find all of the PA Health and Wellness providers that offer home care for participants. Please note, they refer to it by an alternate name here (in home supportive care), but it means the same thing. Also, as you’ll see, the website doesn’t have the same functionality as Keystone First. Therefore, you cannot click the link directly to provider search results.

As mentioned, you’ll also find Chosen Family Home Care as a qualified PA Health and Wellness provider should you need home care, home health aides, or personal care aides in and around Philadelphia. We offer superior personal assistance services throughout the greater Philadelphia, Pennsylvania region. 


Find these related topics in home care and waiver services to assist seniors along the way:


Overall, you can search PA Health and Wellness for a variety of services and offerings. They include the following groupings:

  • Medical professionals
  • Medical facilities
  • Vision
  • Pharmacy
  • Long term supports and services, including home care agencies and caregivers
  • Dental and vision

 

Alternatively, you can simply look up the provider in question by name. 

UPMC

medicaid providers with community healthchoices

Finally, we have the UPMC provider search option that we spell out here. 

Main landing page for UPMC CHC waiver provider searches.

From the main landing page, you can select providers based on the following options:

  • Medical
  • Behavioral health
  • Dental 
  • Vision
  • Home and Community Based Services
  • Pharmacy

 

From there, you can drill down deeper into further categories. For example, by selecting medical specialists from the “medical” tab.

Some of the more popular options for Home and Community Based Services include, and within a 20 mile radius of center city Philadelphia are:

Home care services: Click here for home care providers within 20 miles of Philadelphia, Pennsylvania. If you’re in need of a quality home care provider, Chosen Family Home Care is a provider of personal assistance services both in Philadelphia as well as Bucks, Chester, Delaware, and Montgomery counties of Philadelphia. 

Find these related topics in home care and waiver services to help you:

 

Home modifications

Home Health Aides

Personal Emergency Response Systems

Home meal delivery

UPMC points out these as popular search items, and this is because these are among the most common services provided under Home and Community Based Services.

Home and Community Based Services for independent living

medicaid waiver providers

Regardless of what your mix of services and supports are, you can rely on the CHC Medicaid waiver to give you the benefits and services you need. Overall, the goals of the program allow seniors and disabled adults access to services that let them remain in the community and even their own homes safely and independently.

For participants that receive home care and personal care services, Chosen Family Home Care is a caring and supportive home care agency serving the greater Philadelphia.

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