Commonwealth Court Rulings Allow HealthChoices Procurement to Proceed

With exact dates still being finalized, the new year (2022) will likely bring significant changes to the Medicaid physical health managed care plans operating across the state. 

In early December the Department of Human Services (DHS) leadership announced that it will implement its HealthChoices (Physical Health) procurement selections following recent rulings by Pennsylvania’s Commonwealth Court.  Two of the four court challenges by dissatisfied managed care plans remain under seal, but DHS officials reported that Commonwealth Court lifted the stay that had been in place and the Department is moving forward with implementation.  DHS intends to soon announce “go-live” dates.

Before bid protests and court challenges paused the process, DHS announced applicants selected through its Request for Applications (RFA) for Pennsylvania’s HealthChoices program, the Medicaid physical health managed care program that provides healthcare coverage to more than 2.7 million people.  Under the new procurement, agreements will be in effect for five years with a state option to extend them for another three years.   

procurement changes by zone chart phlp 2

New plans per DHS RFA 07-19 announcement in bold; strikethrough for plans that will no longer be offered. 

Rather than issuing separate procurements for each HealthChoices region, as it had done in the past, DHS combined the contracting process for all of its regional zones for the first time in 2015.  This change, combined with the program’s enrollment growth following Medicaid expansion, attracted unprecedented interest from both regional and national insurance companies.  Legal challenges to the procurement process from dissatisfied bidders derailed DHS’ previous two attempts to reprocure the physical health managed care program.  The current HealthChoices program has been operating under extensions of contracts originally awarded in 2012.  Current enrollment by plan and zone can be found here

PHLP will keep readers informed as additional procurement information is released.