Pennsylvania Health Choices
Pennsylvania Health Choices
HealthChoices is the name of Pennsylvania's managed care programs for Medical Assistance recipients. Through managed care organizations, eligible individuals receive quality physical and behavioral medical care, as well as long-term supports.
There are two types of plans. One covers your physical health.
Another covers your behavioral health.
Physical HealthChoices
https://www.dhs.pa.gov/HealthChoices/HC-Services/Pages/PhysicalHealthChoices-Main.aspx
The Physical HealthChoices program is the name of Pennsylvania's mandatory managed care programs for Medical Assistance recipients.
Through physical health managed care organizations (MCOs), recipients receive quality medical care and timely access to all appropriate physical health services, whether the services are delivered on an inpatient or outpatient basis.
The Department of Human Services' Office of Medical Assistance Programs (OMAP) oversees the physical health component of the HealthChoices program.
Behavioral HealthChoices
Mental health and drug and alcohol services provided via the HealthChoices program differ from the physical health component of the HealthChoices program.
For mental health and drug and alcohol services, each county contracts with a managed care organization (MCO).
Once you are enrolled with the MCO, you continue to have choices as to who provides your services.
To find your Managed Care Org (MCO) please go to this site.
https://www.dhs.pa.gov/HealthChoices/HC-Services/Pages/BehavioralHealth-MCOs.aspx
Remember, the MCO can change as it has a contract with each county and must be renewed at the end of the contract life.
The MCO will send you a handbook outlining how to access services and outlining the benefits available to you.
If a practitioner is a HealthChoices participating provider, and is accepting new clients, you have the right to see that doctor.
Under the behavioral health component of the HealthChoices program, counties are required to ensure high-quality care and timely access to appropriate mental health and drug and alcohol services, and to facilitate effective coordination with other needed services.
Each HealthChoices consumer is assigned a Behavioral Health Managed Care Organization (BH-MCO) based on his or her county of residence.
Members, then, have a choice of behavioral health care providers within the BH-MCO's network.