1. National Association of Medicaid Directors November 8, 2016
Jennifer Burnett, Deputy Secretary
Department of Human Services Office of Long-term Living

2. History of Managed Care in Pennsylvania
Mandatory Medicaid managed care was introduced in the 5 county Philadelphia area in 1997.
Implemented through a geographically phased roll-out.
Completed statewide implementation in 2013
MA total enrollment:  2.8 million (as of Oct 2016; includes newly eligible under Medicaid Expansion)

3. The Basics What is Community HealthChoices (CHC)?
CHC is a Medicaid managed care program that will include physical health benefits and long-term services and supports.
Who is part of CHC?
Individuals who are dually eligible for Medicare and Medicaid
Individuals who are eligible for Medicaid long-term services and supports (LTSS) because they need the level of care provided by a nursing facility

4. CHC Population Duals in Waivers 49,759 Non-Duals in Waivers 15,821
Duals in Nursing Facilities
77,610
Non-Duals in Nursing Facilities
7,314
Non-LTSS Duals
270,114
TOTAL
420,618
9/18/2018

5. Community HealthChoices Goals

6. CHC Roll Out
9/18/2018

7. Readiness Review
Measures readiness of Managed Care Organizations (MCO) prior to CHC going-live
Readiness Review criteria and benchmarks are set by the Department
Completed as desk review and on-site
Readiness Review Teams:
One team will be assigned to each MCO
Average team consists of 3-4 staff from the
Department Each team will have up to 10 Subject Matter Experts (SME)
CHC Readiness Review will review all LTSS components. Physical Health will be reviewed in conjunction with HealthChoices.

8. Launch: Indicators to be Reviewed
Participants are enrolled and receive LTSS services without interruption
Service Coordination is functioning well
LTSS providers continue delivering services and are paid promptly
Networks are Robust
Communication is effective (stakeholders have the information they need)