State changing medical services
Dual recipients of Medicaid and Medicare received letters in August from the state Department of Human Services giving them notice of a mandatory change taking effect in January.
The Community HealthChoices program will affect more than 420,000 Pennsylvanians, including thousands in Blair and surrounding counties. It sets out to coordinate all medical services they receive including their long-term, in-home care so they can live independently and stay out of nursing homes, said Jennifer Burnett, deputy secretary for the Department of Human Services Office of Long-Term Living.
Community HealthChoices aims to coordinate all services through one of three managed care organizations: AmeriHealth Caritas, PA Health & Wellness and UPMC Community HealthChoices. The state will then pay a per-member, per-month amount to those organizations.
People enrolled in Medicare and Medicaid medical assistance programs, people enrolled in Medicaid waivers for physical disabilities and older adults as well as Medicaid-eligible people in nursing facilities will be affected by the change.
Community HealthChoices will not change Medicare benefits, according to the department. However, participants may choose to have the same managed care organization provide their home care services and Medicare coverage. That will improve coordination between Medicare and Medicaid.
“There is no communication between the health care system and long-term care system right now. What we are doing here is providing resources so if people want to stay at home, they can,” Burnett said.
“This deters facility placement,” Burnett said.
John Lovelace, UPMC Health Plan president of government programs, said that in-home, long-term care is “completely divorced” from health care and that is a clumsy relationship leading to more nursing placements.
“Nobody really wants to go to a nursing facility,” Lovelace said.
He cited an annual AARP study that named Pennsylvania in the bottom 15 states for the percentage of people who receive services at home.
“We’ve been in the bottom 15 states for quite a long time,” he said.
“The way it works now is the nursing home is the only practical option. There are agencies for long-term care … providing an aide helping you get out of bed, bathing, dressing, making meals. … But there is a disconnect from your physician who may have changed your prescription and who may not know these services are in your home. With Community HealthChoices, we can connect physicians to those services in a straightforward way to support patients holistically.”
The requirement to choose a managed care organization does not require a participant in a nursing home to move to a different one, according to the Department of Human Services. And there are no extra costs for Community HealthChoices participants. But they are tasked to choose from among the three managed care organizations by January or they will be automatically enrolled in one, Burnett said.
“If they are auto-enrolled, they can change at any time,” she said.
The state’s LIFE program is an alternative to the three managed care organizations.
Living Independence for the Elderly, or LIFE is Pennsylvania’s existing voluntary managed care program.
The LIFE Program offers the same type of coordination that the other three managed care organizations are to provide and is going to continue.
The biggest difference between the other organizations and LIFE is that the LIFE program has geographic boundaries and only serves people 55 years old and older.
Senior Life in Altoona is preparing for more members, said Lisa Hart, Senior Life Altoona outreach coordinator.
“The three managed care organizations you will choose will cover all services you need. Or you could pick the LIFE program.”
Joanne Litzinger, 88, of Altoona, uses Senior Life to live independently.
“It’s been a blessing for me. I was married 68 years. My husband passed away. And Senior Life takes care of all my needs. I have nothing but positive things here. I live by myself and three days a week come here.”
Medicaid and Medicare dual recipients can expect to receive another notice of the Community HealthChoices change in September.
“They will get a packet laying out what services are available through each managed care organization so they can choose,” Burnett said.
Mirror Staff Writer Russ O’Reilly is at 946-7435.
IF YOU GO:
Senior Life has scheduled the following informational meetings on Community HealthChoices:
Sept. 6 — 11 a.m.
Oct. 9 — 5:30 p.m.
Nov. 10 — 1 p.m.
All meetings will be held at Senior Life, 1311 12th Ave., Altoona.