UPDATE 5/25/2022: See this more recent article for updates to the below information, including new effective dates and timelines.
Department of Human Services (DHS) leadership announced in mid-January that they intend to implement changes to the managed care plans operating the physical health HealthChoices program effective July 1, 2022. This launch date is contingent on all parties reaching agreement on rates and the managed care plans passing the DHS readiness review process. This follows recent rulings by Pennsylvania’s Commonwealth Court allowing DHS to proceed with its managed care reprocurement.
Approximately 460,000 Medicaid consumers will be required to choose a new managed care plan or be auto-assigned into one. The remaining 2.3 million consumers in the HealthChoices (PH) program will have the option to choose a new managed care plan and will have new plan options available.
All impacted Medicaid consumers will be mailed notices regarding their managed care enrollment options in early May. State officials intend to give consumers just under 60 days to make any plan enrollment selections. DHS will use its enrollment contractor, PA Enrollment Services, to mail notices, do additional outreach to vulnerable populations, and process plan changes.
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 DHS option to extend them for another three years.
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.