Gov. Tom Wolf says he believes all Pennsylvanians in their later years should have the ability to continue living at home like his 94-year-old mother, even if they become frail and develop disabilities.
In touting his Community HealthChoices initiative in Lawrenceville Thursday, he mentioned his mother’s options late in life as an example of what the program is intended to provide starting Jan. 1 for those older or disabled adults who rely on government-subsidized health and long-term care services.
“We want to make sure we are providing choices ... and doing it in the fairest possible way,” Mr. Wolf said at the Stephen Foster Community Center, while joined by Cabinet secretaries in addressing senior center attendees, local officials and others affected by the new program.
About 80,000 individuals in 14 southwestern Pennsylvania counties — most of whom qualify for both Medicare and Medicaid support — will be the first in the state participating in Community HealthChoices. The program requires them to enroll with one of three state-contracted managed care organizations to coordinate their long-term care and health services. Statewide expansion over the next two years will eventually affect some 400,000 Pennsylvanians.
The goal, according to state officials, is to better monitor and integrate the different types of care people receive at doctors’ offices, hospitals, nursing homes and their own homes in order to keep them healthier longer. The managed care organizations have financial incentives to help their clients reduce unnecessary institutional care, boost their access to home and community services and maintain their independence longer.
Government-backed managed care programs for physical health services have been relatively common, but with Community HealthChoices, Pennsylvania is joining about two dozen other states using it for long-term care services. That would include Medicaid-funded support such as home care aides and adult day care that are provided under existing “waiver” programs for those who qualify by age, income and/or disability.
Information about the program sent in recent months to those affected engendered considerable confusion and uncertainty, some of which continues.
“They don’t understand it and think they don’t have a choice,” said Leslie Cejrowski, service coordinator at the Stephen Foster center. “Anything new, especially with seniors — change is not good for them.”
But state officials said 54 percent of the 80,000 affected in the region on Jan. 1 have voluntarily selected a managed care organization, which they described as higher than other states. The other 46 percent had one of the three insurers assigned to them, though people can change their MCO. There is also a transitional period of three to six months in which individuals may continue all of their existing services, regardless of their MCO network.
State officials made repeated references Wednesday to how what’s learned from the program’s roll-out in the Pittsburgh region will help make sure Community HealthChoices works best for the rest of the state eventually.
“Is it going to be perfect? I don’t think so,” acting Human Services Secretary Teresa Miller acknowledged of the startup. “There are always going to be bumps in the road.”
Mark Lewandowski, a driver for the Stephen Foster center’s Meals on Wheels program, told the governor that the many homebound individuals he delivers to are worried about various government-supported services being cut.
Under Community HealthChoices, Mr. Wolf responded, funding and services will not be reduced. The hope instead is to make more efficient use of the $6 billion in Medicaid funding on long-term care services, while giving people what they prefer.
“The goal is to do a better job, not cut back,” he said, suggesting failure would come only if people don’t believe their options have improved.
Gary Rotstein: grotstein@post-gazette.com or 412-263-1255.
First Published: December 7, 2017, 9:50 p.m.
