Court Ruling Delays Pennsylvania’s Plan for Changes to Medicaid Managed Care Program

Pennsylvania-Map-articlePennsylvania has been in the process of choosing new managed care organizations (MCO) to provide physical health services for HealthChoices, the state’s Medicaid managed care program. The contract awards to MCOs – which had been announced in early 2017 – have been on hold as several insurers had requested a review of the bid process.

In rulings issued on April 9 and 10, 2018, the Pennsylvania Commonwealth Court ruled in favor of Aetna, United Healthcare, and Vista Health Plan, the insurers that were disputing the bid process. The court order cancels the state’s contract awards, according to a report published in the Central Penn Business Journal.

Pennsylvania’s Department of Human Services has not yet announced its next steps in the procurement process.

The court decision does not affect Community HealthChoices, Pennsylvania’s new managed care program to provide long-term care for older Pennsylvanians and individuals with physical disabilities so they can remain in their homes while receiving services. Community Health Choices launched in Western Pennsylvania in January 2018 and will roll out to the remainder of the state in phases. Get details here.

Additional Resources

DHS offers more information on its HealthChoices program for physical health services, including a map of current MCOs and the counties in which they operate, here.

The Pennsylvania Medical Society (PAMED) will continue to follow any developments concerning HealthChoices and share updates with our members.

PAMED members with questions can contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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