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Long-Term Services and Supports

Senior couple with a dog and elderly woman in wheelchair holding a baby. An extended family on a walk in autumn nature.
A mother in a wheelchair plays with her daughter.
An elderly woman smiles at the camera.

We work to protect the health care rights of seniors and individuals with disabilities. We do this by ensuring that consumers have access to health systems that honor individual choice, protect their rights and dignity, and help them live meaningful lives at home and in the community.   

Long-Term Services and Supports (LTSS) refers to services and supports that meet the needs of people with chronic conditions who cannot independently care for themselves. LTSS can be provided at home, in the community, or in facilities like nursing homes.  Home and Community Based Services (HCBS) programs, sometimes called "Waivers", are one type of LTSS. Waivers provide an alternative to institutional care for individuals who wish to remain at home. Many are not aware of Waivers, how to qualify, or how to access these programs. PHLP works to break down these barriers and keep individuals informed about services available to them and how to make the most of them.

PHLP's work focuses on three areas related to LTSS:  1) Community HealthChoices (CHC);  2) Home and Community-Based Services (HCBS), also known as Waiver programs; and 3) Dual Eligibility (the term for people who have both Medicare and Medicaid insurance.)  More information about our work in each of these three areas can be found below.  

  • Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for people over 65 and adults 21-64 with physical disabilities. CHC participants, who include dual eligibles as well as people in certain HCBS programs, select a managed care plan (a CHC Plan) to deliver their medical assistance benefits. In addition, for participants who require long term care, the CHC Plan covers a full range of home and community-based services and may support nursing home care if needed. CHC plans aim to provide better coordination between physical health providers, home and community-based services, and Medicare. 

    PHLP has been actively monitoring CHC and serving as a leading advocate for CHC participants since before its implementation in January 2018. PHLP advocates on behalf of CHC participants in a number of settings, including workgroups with state officials and appeals against CHC plans on behalf of individuals.

  • Home and Community Based Services (HCBS programs) are Medical Assistance programs that provide seniors and people with disabilities with a range of supportive services that allow them to live independently in their homes and communities. They are an essential alternative to nursing homes or other institutional care. Eligibility for these programs depends on income and resources, need for assistance, and the availability of funds. PHLP strongly believes that seniors and Pennsylvanians with disabilities who receive Medicaid should have access to these vital services that enable them to live with dignity and independence in their own homes, rather than in nursing homes. PHLP monitors issues affecting HCBS participants in several ways, including helping individual clients, engaging in systemic advocacy work, and participating in statewide advisory committees.  PHLP also does outreach and education about HCBS programs for participants, family members, and the providers who serve them.

    PHLP has been actively monitoring CHC and serving as a leading advocate for CHC participants since before its implementation in January 2018. PHLP advocates on behalf of CHC participants in a number of settings, including workgroups with state officials and appeals against CHC plans on behalf of individuals.

  • There are over 400,000 Pennsylvanians who have both Medicare and Medicaid. They are sometimes referred to as “dual eligibles.” They are low-income seniors and people with disabilities who share the underlying feature of poverty. These individuals can have trouble navigating these two complicated health care systems, often feeling lost in a maze of multiple doctors, medications, and programs. At rates far higher than the general population, they bounce in and out of emergency rooms, hospitals, and nursing homes, often experiencing poor care and unnecessary complications.

    Through community education and policy advocacy at the state and federal levels, PHLP works to remove barriers that exacerbate the health care disparities faced by dual eligibles.

    PHLP has been actively monitoring CHC and serving as a leading advocate for CHC participants since before its implementation in January 2018. PHLP advocates on behalf of CHC participants in a number of settings, including workgroups with state officials and appeals against CHC plans on behalf of individuals.

Jeff Skeba

Tagged: Community HealthChoices (CHC)

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