The Pennsylvania Department of Human Services began mailing flyers to aged and disabled residents who receives Home and Community Based Services (HCBS) through one of the existing Medicaid Waivers (Aging Waiver, Attendant Care Waiver, Independence Waiver, OBRA Waiver and COMMCARE Waiver) or an individual who is dually eligible for Medicare and Medicaid, that will be transferred into the new Community HealthChoices managed care program.
Under the Wolf administration initiative, those who qualify for government-funded services due to their health and income limitations will be expected to choose one of three state-contracted Managed Care Organizations to coordinate their health and long-term care services. The MCOs will replace more limited service coordination that needy individuals have been receiving through Area Agencies on Aging or other government contractors.
State officials maintain that the current system of spending some $6 billion in Medicaid funds on nursing homes, home assistance and other long-term care services results in excessive institutional care. They suggest a managed care system will provide financial incentives leading to more preventive health services that avoid unnecessary hospitalizations and more home assistance that reduces nursing home use.
The service coordinators Medicaid beneficiaries presently use for long-term care help — such as arranging aides who visit homes — have no role in planning and awareness of doctors’ visits and other medical-related care that is often paid by Medicare. Community HealthChoices is designed to provide more comprehensive management of all those government-funded services.
“The data is pretty disturbing about how many preventable hospitalizations are out there from lack of coordination,” said Jennifer Burnett, deputy secretary of the state’s Office of Long-Term Living.
She acknowledged, however, that the state has a large task in educating consumers about the looming changes and decisions. Affected individuals will receive notice informing them about when and how to choose an MCO. Some public information sessions are also anticipated in September and October in the counties affected, which will be followed by a broader state roll-out that ultimately affects some 400,000 Pennsylvanians.
Medicaid beneficiaries satisfied with their current services may keep them for at least 180 days after Jan. 1 with no changes in coordination or providers. After that, coordination will be taken over by one of three health insurance-related MCOs that won state contracts — UPMC Community HealthChoices, PA Health & Wellness, and AmeriHealth Caritas. The three are presently arranging their own networks of home care agencies, nursing homes, adult day services and other providers they will be working with. Providers are likely, in many cases, to work with multiple MCOs after negotiating rates separately for what the insurer will pay them.
Original source: Gary Rotstein, Pittsburgh Post-Gazette, Aug 4, 2017. Website accessed: Oct 1, 2018