08 Nov Pennsylvania’s CHC Medicaid Waiver: A Guide to Services at Home
For older adults, Community HealthChoices (CHC) provides physical health benefits as well as long-term services and supports to eligible individuals, like disabled adults and elderly people. Let’s take a look at the benefits and services offered by Pennsylvania’s CHC Medicaid program for Home and Community Based Services (HCBS) for eligible disabled adults and seniors. These services are also considered as Long Term Services and Supports.
What is Community HealthChoices?
Community HealthChoices is a state Medicaid program. It’s a part of Pennsylvania’s CHC Medicaid waiver. The program allows companies, called managed care organizations (MCOs), to coordinate medical care and long-term services and supports (LTSS). It directs care and services for people that qualify for Medical Assistance and Medicare plus 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. There are three companies that are managed care organizations for Community HealthChoices. In and around Philadelphia and the Greater Delaware Valley, these are UPMC, Keystone First, and PA Health and Wellness.
What are long term supports and services (LTSS)?
Long-term services and supports (LTSS) are defined as the services and supports used by individuals of all ages with physical limitations and chronic illnesses. These individuals who need assistance need help in their ability to operate or function in one or more ways in their daily lives. For example, these routine functions include activities of daily living that are difficult or impossible for people to perform without assistance such as bathing, dressing, preparing meals, and administering medications.
What do long term services and supports look like in one’s home?
LTSS can be provided in a nursing facility or in one’s own home and community. Services you receive at home and in your community are known as home and community based services (HCBS). These services are based on your needs after an individual evaluation and assessment. They are documented in one’s person-centered service plan by a service coordinator.
What is a service coordinator?
A service coordinator (SC) is an assigned role by the health plan. They are jobs and roles that oversee a number of cases. They review an individual’s circumstances through regular assessments. With that, they then determine the services and supports that the person needs to help keep them living independently and safely in their own homes. Examples include home care, home delivered meals, and transportation, among others.
Am I eligible for the Medicaid CHC waiver and long term services and supports (LTSS) in my own home?
Check out our full guide on the Medicaid waiver to determine if you are eligible.
I hear that family members or friends can get paid to take care of loved ones. Is this true?
In some cases, yes. Read our full article on getting paid to care for a loved one for more information.
What are the services available under the CHC Medicaid Waiver for home and community based services?
Below we share some examples of the kinds of HCBS covered by Community HealthChoices. Keep in mind one must both be eligible and with a need determined by the health plan before a service or services are provided.
Adult daily living, also known as adult day care
Adult Day Care Centers are designed to provide care and companionship for older adults who need supervision or assistance during the day. Programs offer relief to family members and caregivers, allowing them to go to work, handle personal business, or just relax while knowing their relative is well cared for and safe. They are generally offered for 4 hours a day or more. They are also scheduled regularly for one or more days a week.
Assistive technology (AT) is any item, equipment, software, or product. It’s purpose is to increase, maintain, or improve the functional capabilities of seniors or those with disabilities.
Career assistance and coaching
There are a variety of job and career related services that HCBS can provide. These include:
- Counseling about whether having a job will help someone support themselves or have a financial benefit.
- Career coaches can provide assessments to identify strengths and interests to uncover potential job opportunities.
- Skills development to help individuals develop the knowledge and tools to get jobs.
- Job coaching to help people find jobs that are a match and to help candidates keep their jobs.
- Job finding services so candidates can discover different career opportunities that exist in the community.
Services that offer self-help, socialization, communication, and other skills that facilitate the ability of the individual to live and thrive in a community. These services are short term and include facilitating a move from a nursing home back into the community, or from one living setting to another.
Community transition services
These are one time expenses allocated to individuals that move from an institutional setting such as a nursing home back into the community (like to one’s own home or an apartment or other living situation). Also known as nursing home transitions, these expenses include items such as security deposits, moving expenses, and household products including furniture.
Home modifications and adaptations
These are changes done on a client’s home that in general make the home safer and more accessible. Some examples include ramps, handrails, and grab bars, among others which can facilitate the senior or disabled person’s independence and ability to thrive. See our list of home modifications that can be done now even for those on a budget.
These are ready to eat meals, delivered straight to the client’s door. These prepared meals are designed for those that cannot prepare or get nutritious meals for themselves. Examples include Meals on Wheels or Mom’s meals.
Home health services
These are services done by professionally licensed staff in the client’s home. Examples include nurses, physical and occupational therapists, and speech therapists. This is not to be confused with non-medical home care services, which you can find more about under personal assistance services (PAS). Understand the difference between physical therapy and occupational therapy here.
Transportation is a key part of Pennsylvania’s CHC Medicaid Waiver program. This helps clients meet their transportation needs and facilitate the ability of them to interact with and be a part of the community. These could include mileage reimbursement, bus tickets and tokens, and other means of transportation. This does not include medical transportation needs, such as visits to and from a hospital or doctor.
Participant-directed community supports and goods and services
This program, under Services My Way, let clients direct their own services and keep a budget. It allows them to hire their own workers as well.
Personal assistance services or home care services
This is hands-on help for activities of daily living for clients, such as eating, bathing, dressing, and toileting. To note, this is the most common service offered and it is one that a large majority of clients will qualify for. While each client who is approved for home care services will have their own schedule of services, the level of hours can and will vary dramatically from person to person based on the level of needs that they have. Chosen Family Home Care, for example, is a local Philadelphia home care provider of compassionate and supportive personal assistance services. Chosen family proudly partners with Community HealthChoices and the medicaid waiver to provide home care services for eligible members.
Personal emergency response system
Personal Emergency Response Systems (PERS), also known as Medical Emergency Response Systems, let you call for help in an emergency just by pushing a button. A PERS has three components: a small radio transmitter, a console connected to your telephone, and an emergency response center that monitors calls and clients. The PERS is covered under Pennsylvania’s CHC Medicaid Waiver.
These are services offered to eligible clients that remove insects and other pests from the member’s home. They are offered when the safety and health risks of pests could prevent the member from continuing to live in the community if left untreated.
Residential habilitation services are for individuals who require assistance to get through the day due to physical disabilities and functional limitations. These individuals still have the ability to live independently at home. However, through residential habilitation services, their quality of life can be improved. This is done by helping them preserve their self-care abilities.
Respite care is essentially a short-term break for caregivers that are caring for their loved ones. The service provides a paid caregiver for the client when an unpaid family caregiver is away or needs a break from providing care. Luckily, Pennsylvania’s CHC Medicaid Waiver helps provide support for these service to some of the millions of family caregivers out there. Read about all the benefits that respite care provides for paid family caregivers.
Specialized medical equipment and supplies
These are supplies and medical equipment that allow the client to increase or maintain their ability to perform activities of daily living.
Structured day habilitation
Structured Day Program services are individually designed services that are provided in an outpatient setting or in the community. They improve or maintain the waiver participant’s skills and ability to live as independently as possible in the community.
A variety of telecare services may be available to clients. These might include remote monitoring devices and sensors that can regularly evaluate and provide feedback on the client’s conditions or health status at regular intervals. For example, a device or sensor can regularly monitor pulse and blood pressure and track these metrics over time. Other examples include medication dispensing technology or the ability to monitor whether medicines are taken regularly. Read more about that with 6 companies and technologies changing home care for the better.
Therapeutic and counseling services
These are counseling and therapeutic services that can provide a wide range of support options under Pennsylvania’s CHC Medicaid Waiver. They can include:
- Cognitive rehabilitation therapy
- Nutritional consultation
- Counseling services
- Behavior therapy
These are physical changes done to a car, van, or truck for clients that have special needs. It is done to allow the client to be able to use the vehicle for transportation and safety purposes.
A note for seniors and disabled adults that need help with hands-on personal care services and home care services
Chosen Family Home Care is a Philadelphia and Greater Delaware Valley-based provider of home care services in Pennsylvania. We are an approved Medicaid Waiver provider of home care and personal care services to Community HealthChoices waiver participants. As a home care agency under Pennsylvania’s CHC Medicaid waiver, we specialize in supportive and compassionate caregivers, and we set ourselves apart from other agencies by treating our caregivers like family.
That means providing our caregivers with the highest pay in the industry, educational and informative ongoing training tools, and regular assistance and communication from our leadership and clinical staff support. For our clients, that means the best care provided and ability to age independently and with dignity.
What if I still have questions about services, such as how to sign up or enroll?
Reach out to Chosen Family Home Care today. We are experts in helping individuals navigate the Medicaid Waiver program. This includes eligibility and enrollment questions, inquiries on navigating the process, and general program questions.