State Medicaid officials reported in September that Gateway Health Plan (Medicaid) ended its contract with DuPont "Nemours" Children's Hospital and affiliated providers on August 31, 2021. This change affects just under 300 families who live in the following counties: Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry, and York.
Gateway, which failed to send a written notice to some of its impacted members within the required 30 days in advance of contract termination, is extending the “continuity of care” period from the normal 60 days to 6 months. Gateway has also mailed corrected notices and is doing telephonic outreach to the families affected. Gateway representatives clarified that its contract with DuPont Hospital ended August 31, 2021, and that its contract with certain affiliated provider groups ends October 1, 2021. To minimize confusion, Gateway has extended the continued care period to March 31, 2022 (six months from later termination date) for all impacted members.
To continue to getting care at DuPont, members will need to either:
- Ask Gateway for a “continuing care” approval, which would continue until March 31, 2022; or
- Switch Medicaid managed care plans.
Children who need continued care for a condition treated at DuPont within the past 12 months, or children who have a previously scheduled appointment, should be approved by Gateway for a continuity of care period. Continuity of care rights are defined in the state’s contract with the Medicaid managed care plans. Members whose request for continued care are denied have appeal rights.
To change Medicaid managed care plans, members should contact PA Enrollment Services at 1-800-440-3989 or go to www.enrollnow.net. Those getting continued care should make their health plan change before March 10, 2022 to ensure the new plan in is place on April 1, 2022.
Gateway members using DuPont hospital or affiliated providers should be aware that two other Medicaid managed care plans in the Lehigh/Capital zone, Aetna Better Health and UPMC for You, currently contract with the DuPont health system. Of these two managed care plans, however, only UPMC for You was selected by the state Medicaid agency as part of its recent reprocurement to continue operating in the Lehigh/Capital zone. There is a legal challenge to the procurement process pending in Commonwealth Court, but unless that challenge succeeds, any Gateway members who change into Aetna now could have to change plans again in 2022 to be able to continue care with their DuPont providers.
Impacted families can request assistance with any care transitions by contacting the Gateway Special Needs Unit at 1-800-392-1147.
Those needing additional help navigating this process can contact PHLP's Helpline at 1-800-274-3258.