Long-Term Services and Supports

We work to protect the health care rights of seniors and individuals with disabilities.  

 

PHLP is commited to ensuring that consumers have access to health and long term care systems that honor individual choice, protect participants' rights and dignity, and help seniors and people with disabilities live meaningful lives at home and in the community.   

Long-Term Services and Supports, or LTSS, refers to services and supports that meet the medical and non-medical needs of people with chronic conditions who cannot independently care for themselves. LTSS can be provided at home, in the community, or in facilities (e.g. nursing homes). PHLP works to increase awareness and improve the effectiveness of Home and Community Based Services (HCBS programs), which are one type of LTSS, and which provide important alternatives to institutional care for individuals who wish to remain living in their homes or communities. Even though HCBS (sometimes called "Waiver") programs have been available for decades, many are not aware of their existence, how to qualify, or how to access these programs. 

We work to ensure that seniors and adults with disabilities understand the LTSS services available to them, and that they receive the services and support they need through these LTSS programs in order to live meaningful and productive lives in the community or other setting of their choice.  Our work includes providing direct legal services and representation to individuals seeking to get or keep LTSS services, providing community education programs for consumers, health care providers, and social service providers, as well as advocating for systemic change related to LTSS. 

Specifically, our 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.

LTSS Quick Facts

  • Medicaid pays for approximately 2/3 of the country's LTSS

  • Pennsylvania’s HCBS (Waiver) programs fall into two major groups: waivers for people with intellectual disabilities or autism, which are run by the Office of Developmental Programs (ODP), and waivers for seniors and people with physical disabilities, which are run by the Office of Long Term Living (OLTL).  

  • Statewide, over 116,000 people are served by Pennsylvania's HCBS programs. 

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