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Behavioral HealthChoices
The Commonwealth of Pennsylvania’s Department of Public Welfare (DPW) has
implemented a program for Pennsylvanians enrolled in the Medical Assistance (MA) program. This program is
called HealthChoices. HealthChoices requires MA recipients to enroll in managed care plans (in some counties)
to help them get services. There are physical health managed care plans and behavioral health managed care
plans. Details of the HealthChoices Program are given in this section.
For more information regarding behavioral HealthChoices or the program in general, check out the state web site at www.dpw.state.pa.us/omhsas/omhchoices.asp Click on the questions to see the answers or scroll down the page.
Community Behavioral HealthCare Network of Pennsylvania
(CBHNP) is the behavioral health plan for residents of the Capital Area (Cumberland, Dauphin,
Lancaster, Lebanon, and Perry Counties) and the NorthCentral Region (Bedford, Blair, Clinton, Franklin, Fulton, Lycoming, and Somerset Counties). We are responsible for managing
mental health and substance abuse services.
Under the behavioral health component of the HealthChoices
program, CBHNP is required to ensure high quality care and timely access to
appropriate mental health and substance abuse services and to effectively
coordinate other needed services.
The HealthChoices program has three goals that guide the
Department of Public Welfare in its implementation efforts. These goals are:
Physical Health Care
Capital Area (Cumberland, Dauphin, Lancaster, Lebanon, and Perry Counties) HealthChoices contracts with managed care health plans to provide physical health care for the Medicaid eligible.
NorthCentral Region (Bedford, Blair, Clinton, Franklin, Fulton, Lycoming, and Somerset Counties)
HealthChoices contracts with physical health care plans in some counties where the Medicaid eligible can voluntarily enroll into the plan or remain in the ACCESS Plus program, the state hybrid of fee for service and managed care which features a primary care case management (PCCM) model as well as Disease Management (DM).
Behavioral Health Care Capital Area and NorthCentral Region (Bedford, Blair, Clinton, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Lycoming, Perry, and Somerset Counties) If you are enrolled in HealthChoices you are entitled to get
behavioral health services. There are four ways you can get these services:
Please contact us right away if you have difficulty getting
the services you feel you need. Use this link for the Member Services toll-free number for your county or area. Our Member Services staff is available 24 hours a day, 7 days a week, and 365 days a year!
To provide health care services to HealthChoices enrollees,
CBHNP established a Provider Network. A network is composed of many
different health care professionals and facilities who deliver the services
included in the benefit package. (The benefit packages for eligible MA
consumers are based on category of assistance, age, and, for some consumers,
the existence of Medicare coverage.) The behavioral health plans provide each
Member with the name of one individual to be the Member’s point of contact.
This individual will explain services and assist the Member in accessing
behavioral health services.
Please call CBHNP with any questions you have or for any
information you may need. Use this link for the Member Services toll-free number for your county or area.
For more information regarding behavioral HealthChoices or the program in general, check out the state web site at www.dpw.state.pa.us/omhsas/omhchoices.asp. I want more details about HealthChoices and Behavioral Health Services. The Commonwealth of Pennsylvania’s mandatory Medicaid managed care program, called HealthChoices (HC), is the largest Medicaid program administered by the Department of Public Welfare (DPW) and consists of three components. The Office of Medical Assistance Programs (OMAP) administers 2 components: the physical health program and the HealthChoices Enrollment Assistance Program. The Office of Mental Health and Substance Abuse Services (OMHSAS) oversees the third component, the behavioral health program that provides mental health and substance abuse treatment services. On February 1, 1997, Pennsylvania introduced an integrated and coordinated health care delivery system known as HealthChoices. The purpose of the program is to provide medical, psychiatric, and substance abuse services to Medical Assistance recipients. The HealthChoices capitated mandatory managed care program is being phased in across the Commonwealth. The needs of the high risk populations included in the HealthChoices managed care program requires broad-based coordination to assure appropriate access, service utilization, and continuity of care for persons with serious mental illness and or addictive diseases. Because of the cross-cutting coordination needs of Medical Assistance recipients, the unique structure of the behavioral health and human service delivery systems administered by the counties, and their over 30 years experience in administering behavioral health services programs, it was determined that county government would be offered the right-of-first opportunity to enter into a capitated contract with the Commonwealth. OMHSAS has successfully implemented HealthChoices in 25 counties in Pennsylvania to date. Implementation began in February 1997 in the Southeast (SE) zone which includes Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties. In January 1999 the program expanded to Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington, and Westmoreland Counties, comprising the Southwest (SW) zone. In October 2001 the program expanded further to include Adams, Berks, Cumberland, Dauphin, Lancaster, Lehigh, Lebanon, Northampton, Perry, and York Counties, comprising the Lehigh/Capital (L/C) zone. With the addition of the Lehigh/Capital zone approximately 895,000 Medical Assistance recipients are covered under HealthChoices. The three HealthChoices zones represent a total of approximately 65 percent of the Medicaid-eligible population in Pennsylvania. Which Medical Assistance (MA) recipients can participate in HealthChoices? Nearly all MA recipients are required to participate in the HealthChoices program. This includes major categories of MA as follows:
The Department of Public Welfare selected a HealthChoices enrollment program to provide independent enrollment assistance services for the HealthChoices program. The HealthChoices enrollment program’s enrollment specialists assist MA consumers in selecting a PH-MCO (Physical Health Managed Care Organization). They can also help a Member access the BH-MCO and behavioral health services.
Contact an enrollment specialist using the toll-free numbers listed below to enroll into a managed care program if you are eligible for Medical Assistance:
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