Statewide medical assistance program changes

Local News

Medical assistance programs will soon change for older adults and people with physical disabilities in Southwestern Pennsylvania.

The state’s Department of Human Services is starting a new, mandatory managed care program: Community HealthChoices (CHC). The change will impact people over 21-years-old who have both Medicare and Medicaid. It will also impact those who receive long-term services and supports.

Those individuals will choose one of three managed care organizations (MCOs), who will then coordinate and provide medical assistance services: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices.

The goal of CHC is to streamline services and improve quality of life.

“The services are not going to be cut back. If anything, they may receive additional services,” said Lori Pavic, Director of Services, Recruitment and Training for Alleghenies Unlimited Care Providers.

Mary Teresa Boxler was born with Cerebral Palsy. Boxler receives in-home help from Alleghenies Unlimited Care Providers and Alleghenies United Cerebral Palsy.

“I was supposed to be gone by the age of 11, the doctors didn’t give me much hope. But here I am, 63 years,” said Boxler, who lives in Richland Township.

Caretakers help her in and out of bed, get dressed, cook, clean, run errands and travel to medical appointments. Boxler said she’s concerned how CHC will impact the medical assistance she receives.

“I’m concerned it will change my doctor and stuff like that because I like the doctor that I go to,” Boxler said.

Around 80,000 people and hundreds of medical care providers in Southwestern PA will be affected. Act 150 participants and people under 21-years-old will not be affected.

The biggest changes will be for providers, including caretakers and service coordinators.

The changes take effect in Southwestern PA on January 1, 2018. The three MCOs will then have six months to choose which local medical providers they want to work with, based on quality of care they provide. 

Boxler said she’s grown close to her caretakers over the years and they know her routine, so she hopes she can continue to work with them.

“I had them since 1981 and I hate to see them go bye-bye,” Boxler said.

Individuals have until Nov. 13, 2017 to pick one of the three MCO’s. After that date, one will be assigned. However, they can switch to another MCO later on.

Anyone with questions about the managed care program change should contact their medical care provider or Community HealthChoices.

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February 07 2021 06:30 pm

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