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Benefits and Services

Community HealthChoices (CHC) provides physical health benefits as well as long-term services and supports to eligible individuals. Let’s take a look at the benefits and services CHC offers.

What physical health services does UPMC Community HealthChoices cover?

UPMC Community HealthChoices covers the same physical health benefits that are available through the Medical Assistance fee-for-service program (ACCESS) and Medical Assistance Adult Benefit Package.

If you are dually eligible for Medicare and Medical Assistance (Medicaid), your Medicare benefits are not changed or affected by UPMC Community HealthChoices. UPMC Community HealthChoices is your secondary Medical Assistance payer instead of the Pennsylvania Department of Human Services.

If you are eligible for long-term services and supports (LTSS), all services available in the Office of Long-Term Living’s home and community based physical disability waiver programs are covered by UPMC Community HealthChoices. Long-term nursing facility care is also covered.

What kinds of LTSS will UPMC Community HealthChoices cover?

LTSS can be provided in a nursing facility or in your home and community. Services you receive at home and in your community are called home and community based services (HCBS). These services are based on your needs, as documented in your person-centered service plan by your service coordinator.

Here are some examples of the kinds of HCBS covered by UPMC Community HealthChoices:

  • Adult daily living
  • Assistive technology
  • Benefits counseling
  • Career assessment
  • Community integration
  • Community transition services
  • Employment skills development
  • Home adaptations
  • Home-delivered meals
  • Home health services
    • Nursing
    • Occupational therapy
    • Physical therapy
    • Home health aide
    • Speech therapy
  • Job coaching
  • Job finding
  • Nonmedical transportation
  • Participant-directed community supports
  • Participant-directed goods and services
  • Personal assistance services
  • Personal emergency response system
  • Pest eradication
  • Residential habilitation
  • Respite
  • Specialized medical equipment and supplies
  • Structured day habilitation
  • Telecare
    • Health status measuring and monitoring telecare services
    • Activity and sensor monitoring telecare service
    • Medication dispensing and monitoring telecare service
  • Therapeutic and counseling services
    • Cognitive rehabilitation therapy
    • Nutritional consultation
    • Counseling services
    • Behavior therapy
  • Vehicle modifications

Does UPMC Community HealthChoices provide behavioral health services?

Behavioral health services are offered through the existing network of behavioral health managed care organizations (BH-MCOs). To find the BH-MCO in your county, call the UPMC Community HealthChoices Health Care Concierge Team.

What are my UPMC Community HealthChoices copays?

If you are a member of UPMC for Life Complete Care or any other Medicare plan, your Medicare copays will not change under UPMC Community HealthChoices. Refer to your Medicare plan for more information on Medicare copays. There are no UPMC Community HealthChoices copays for medical services and generic medications. There is a $3 copay for brand-name medications.

Copays do not apply to pregnant participants.

Does UPMC Community HealthChoices provide any services not provided by Medical Assistance?

Yes. As a participant of UPMC Community HealthChoices, you may be eligible to receive additional value-added benefits. These include:

$500 dental allowance. This allowance can be used towards certain dental procedures after a benefit limit has been reached. If the procedure cost exceeds $500, you will be responsible for any cost over the $500. A prescription from a participating provider is required. Refer to Summary of Benefits for additional dental benefit information.

$100 vision allowance and glasses fitting each year. This allowance can be used toward purchasing new glasses (one frame and two lenses) or contact lenses (one pair) and one fitting per year. If the cost of the glasses or contact lenses is more than $100, you will be responsible for any cost over the $100. You must have a prescription from a participating provider. Refer to Summary of Benefits for additional vision benefit information.

Extended coverage of personal assistance services. This service will provide personal assistance services to eligible participants who cannot perform activities of daily living and are at risk of entering a nursing facility. Eligibility is based on a state determination of nursing facility clinical eligibility and a pending application with the county assistance office.

Health coaches. This service provides one-on-one coaching to help you eat healthier, lose weight, reduce stress, and quit smoking. Health coaches can also help you manage symptoms and provide treatment options for heart disease, asthma, COPD, low back pain, diabetes, or depression.

AnywhereCare.** This service lets you access a UPMC provider via live video from your computer, tablet, or smartphone—anytime, day or night. This service is best for minor issues such as colds, the flu, sore throats, skin rashes, and other nonemergency conditions.

Stress management program. This service provides online access to a program to help you feel more confident, overcome setbacks, and take control of your life and mood.

Medical Assistance redetermination assistance. This service provides assistance to help you maintain your Medical Assistance eligibility, so you do not lose access to your Medical Assistance benefits.

UPMC Community HealthChoices participants who are Nursing Facility Clinically Eligible (NFCE), may be eligible for additional services including:

Enhanced community transition services. This service offers an allowance of up to $5,000 to assist participants who are transitioning from a nursing facility to the community. The allowance can be used on a variety of items, including household supplies, essential furniture, general moving expenses, security deposits and other items associated with personal and environmental health and safety assurances. (This service exceeds the $4000 lifetime maximum benefit provided by the Office of Long-Term Living's waiver program.) UPMC Community HealthChoices will administer this benefit in conjunction with a nursing home transition team, led by the participant, which will develop a budget for distributing these funds to support the facility-to-community transition.

**UPMC Community HealthChoices participants can seek treatment through UPMC AnywhereCare. UPMC Community HealthChoices participants located in Pennsylvania at the time of the service will have a virtual visit with a UPMC-employed provider. UPMC AnywhereCare virtual visits are not covered services when UPMC Community HealthChoices participants are traveling outside of Pennsylvania.

Frequently Asked Questions Eligibility

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