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 will CHC cover?

If you are dual eligible for Medicare and Medicaid, your current Medicare benefits will not change or be affected by CHC. Your CHC Managed Care Organization (MCO) will become the secondary Medicaid payer instead of the current fee-for-service arrangement through the Pennsylvania Department of Human Services.

CHC will cover the same physical health benefits that are currently available through the Medicaid Adult Benefit Package. You will continue to be eligible for any medical services you currently receive as long as they are medically necessary.

If you are eligible for long-term services and supports (LTSS), all services currently available in the Office of Long-Term Living’s home and community based waiver programs will be included in CHC.

What kinds of LTSS will CHC cover?

LTSS can be provided in a nursing facility or in your home through home and community based services (HCBS). The services you receive 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 through CHC:

  • 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

How will I get behavioral health services through CHC?

Behavioral health services will be 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.

If I choose UPMC Community HealthChoices, what will my copays be?

If you are a member of UPMC for Life Dual or any other Medicare plan, your Medicare copays will not change under UPMC Community HealthChoices. Copays for Medicaid benefits can be found in the Summary of Benefits.

Copays do not apply to pregnant members.

Does UPMC Community HealthChoices provide any services not provided by traditional Medicaid?

Yes. As a member of UPMC Community HealthChoices, you are 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.

$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 exceeds $100, you will be responsible for any cost over the $100. A prescription from a participating provider is required.

Extended coverage of home and community based services. This service will provide personal assistance services to eligible members who are unable to perform activities of daily living and are at risk of entering a nursing facility. Eligibility is based on a nursing facility clinical eligibility assessment and pending application with the county assistance office.

Safelink Android smartphone. This free smartphone for eligible participants comes with 350 minutes of talk and unlimited text.

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. Use AnywhereCare for minor issues such as colds, flu, sore throats, skin rashes, and other nonemergency conditions.

Maternity program. This service can help pregnant women get the support and care they need to have a healthy baby.

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.

Medicaid redetermination assistance. This service gives you help with maintaining your Medicaid coverage to make sure you do not lose access to your Medicaid benefits.

Additional services are available to UPMC Community HealthChoices members who are Nursing Facility Clinical Eligible (NFCE), including:

Caregiver support program. This service offers individualized coaching support for caregivers through in person home visits and through a user-friendly technology platform. Eligible caregivers may also receive a daily stipend based on the participant’s level of need.

Enhanced community transition services. This service offers up to $6,000 yearly allowance to help participants who are transitioning from a nursing facility to the community. The allowance can be used on a variety of items such as 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 state’s fee-for-service Medicaid 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.

Temporary rental assistance. This service provides rental assistance to those whose only barrier to transition from a nursing facility to the community is access to affordable housing. The benefit may provide rental assistance for up to 24 months for those participants who have applied for a permanent subsidy program and where the subsidy is likely to become available within the 24-month period. The benefit will cover rent in the amount that would be covered under the subsidy program and will be administered in conjunction with the nursing home transition team.

**UPMC Community HealthChoices members can seek treatment through UPMC AnywhereCare. UPMC Community HealthChoices members 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 members are traveling outside of Pennsylvania.

Frequently Asked Questions Eligibility

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