Health care confusion
Large packets recently arrived in the mailboxes of 128,000 residents of southeastern Pennsylvania, many of them older adults who rely on both Medicare and Medicaid for their health care needs. The mailing contained information about Community HealthChoices, Pennsylvania’s new mandatory Medicaid-managed care program that significantly changes how health care, nursing home care, and other services in the home and community are provided.
Community HealthChoices is a new approach to Medicaid-covered long-term services and supports instituted by Gov. Wolf to increase efficiency in coordinating longterm care and health services for two groups—low-income older Pennsylvanians and people with physical disabilities age 21 and older. The new setup is supposed to help more people to continue to live in the community instead of nursing homes. But the speed with which the changes are being made may reduce access to services and increase stress on consumers and caregivers alike.
The program begins in southeastern Pennsylvania on January 1. By November 17, people in Bucks, Chester, Delaware, Montgomery and Philadelphia counties who are moving to Community HealthChoices are required to enroll in one of three managed care plans. If they don’t, they will be assigned to a plan, although they may change their plans at any time. And they will be receiving all Medicaid-covered care through the managed care plan. Community HealthChoices started in southwestern Pennsylvania earlier this year, with considerable confusion among consumers and providers, and will expand to the rest of the state in 2020.
The coming change is already creating confusion among consumers and their caregivers in our area, given that they are accustomed to the current system and that program materials, mailed by the state, can be easy to ignore and hard to understand. Community social workers and current providers are confused as well.
Many consumers worry that the new system will cause them to experience problems accessing their doctors, interruptions in their health care, or cuts in the services that allow them to live at home. Others may be using a managed care system for the first time and are unsure how it operates. Challenges are particularly pronounced for those who struggle with lower levels of literacy, cognitive impairment, and limited English proficiency and //who may have a greater need for culturally-competent providers. In addition, LGBTQ older adults face unique disparities in healthcare relating to provider insensitivity, social isolation and discrimination.
Any individual who has experience navigating through the health care system knows how complicated it can be. Under Community HealthChoices, consumers will have to access Medicaid providers through their plan’s network. Some individuals may lose access to their preferred providers; others may be overwhelmed by the need to keep track of the changes and the worry about losing connections with trusted providers.
The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) is prepared to offer unbiased, verified information to limit confusion and help these consumers and their families navigate this challenge.
For more than 40 years, CARIE has been helping elders navigate challenges in the health care system, for patients being discharged from the hospital too soon, older adults overcharged by medical providers, disabled persons denied coverage for a wheelchair, daughters worried about mothers who can no longer live alone.
CARIE recognizes that the coming Community HealthChoices is a daunting and worrisome change for vulnerable Pennsylvanians. We’ve prepared to help by developing easy-tounderstand explanatory materials. CARIE also operates a “helpline” that is available to anyone who would like an advocate to take the time to talk about these changes, answer questions and troubleshoot problems. Residents statewide are encouraged to call 215-545-5728 or toll free at 1-800-356-3606. In addition, as the Community HealthChoices program goes into effect, we will work to identify problems and systemic issues and advocate for more protections if they are needed.
This massive shift in the provision of health care can’t help but be difficult, but CARIE will do all it can to preserve the health, independence and dignity of the elders in our community. Email: Phone: Fax: