Ward Garner, a senior vice president and certified financial planner, has been assisting clients for Bill Few Associates in Ross since 1995
State officials in charge of the new Community HealthChoices managed care program affecting 80,000 mostly low-income southwestern Pennsylvanians view its start positively, but that opinion is not quite universal.
“At seven weeks we can certainly call the launch a success,” Kevin Hancock, acting deputy secretary for the Office of Long-Term Living, pronounced Feb. 15 during a monthly webinar held by state officials to apprise anyone interested about developments with Community HealthChoices.
The CHC program is a Wolf administration initiative to overhaul how long-term care services — especially in-home help — and other supports are delivered to government-subsidized individuals (mainly those who qualify for both Medicare and Medicaid due to some combination of age, income and health status). It began with mandatory enrollments with managed care organizations by Jan. 1 for those affected in 14 southwestern counties, with other parts of the state to be covered starting in 2019 and 2020.
The program is supposed to better coordinate care and services for frail individuals to help keep them out of nursing homes. It’s a rather confusing, complex initiative for the average person to grasp, however, so to smooth its introduction, consumers who were already receiving subsidized home services are under a six-month “continuity of care” period. It’s supposed to ensure nothing would immediately be interrupted or removed from them as a result of the CHC change.
Mr. Hancock said that for state officials, one key indicator of a successful launch has been the minimal number of complaints that anyone did, in fact, have services disrupted. Secondly, the goal was to make sure that providers such as home care agencies would be paid efficiently for their services, just as they were by the state before the managed care organizations began taking responsibility.
He acknowledged there have been some payment delays — “We know there there are individual cases where there is opportunity for improvement” — but described them as limited in nature and already addressed, for the most part.
To those awaiting payments for services they have been rendering, however, the delays are a huge issue.
Debbie Probst, a paid caregiver in Beaver Falls since 2009 for her 28-year-old daughter, who has multiple disabilities, told me this week that the paychecks Ms. Probst was entitled to since Jan. 1 were delayed until Feb. 16, which put her several thousand dollars behind. Ms. Probst is part of a long-existing program of consumer-directed care in which individuals with disabilities can hire relatives or acquaintances — instead of an agency — to help them manage at home, and Ms. Probst said she receives $11 an hour (when the paychecks are coming, that is) to assist her daughter.
Ms. Probst said her daughter was among the thousands mandated to pick one of the three managed care organizations to help coordinate her services, and she chose UPMC Community HealthChoices. But somehow her information was not in a computerized system set up for such payments to continue, and Ms. Probst said her efforts were unsuccessful for weeks in trying to straighten it out through contact with the UPMC entity, the state Office of Long-Term Living, the state-contracted company known as PCG Public Partnerships that has traditionally paid her, or Penny’s Healthcare Services, the state-contracted service coordinator that has been serving the family.
“I still have to take care of her — she’s my daughter — but there’s a glitch in the system, and some people got missed, and everybody keeps passing the buck,” Ms. Probst said.
Some home care agencies have also not received timely payments since Jan. 1, I have been told in interviews with them, but it is unclear how many. The home care agencies have been reluctant to go on the record with their complaints, fearing the managed care organizations will be unhappy with any criticism and avoid using them in the future.
The problem evidently stems from failure to have information and authorizations about all of the 80,000-plus participants promptly and smoothly entered into the data system of HHA eXchange, a company used by the three managed care organizations to process client information. A state official said on the Feb. 15 webinar that such glitches are expected to all be resolved by March.
UPMC Community HealthChoices is the MCO chosen by 52 percent of those enrolled in the southwest. PA Health & Wellness was chosen by 28 percent and 20 percent selected AmeriHealth Caritas.
Several consumer advocacy groups have been closely monitoring the program’s start, and in interview, their representatives largely confirmed Mr. Hancock’s statement that services have continued smoothly for those enrolled.
The biggest hitch, from their viewpoint, has been the confusion that has existed among consumers between Medicaid and Medicare services ever since Community HealthChoices was first mentioned to them. (CHC is a Medicaid program, and people may continue the Medicare health services and providers they’ve had all along.) Mr. Hancock agreed, saying on the webinar that the state intends to do a better job of educating the public when the program is introduced in the Philadelphia area next year.
Gary Rotstein: firstname.lastname@example.org or 412-263-1255.