HealthChoices Is Expanding to Your County in 2012
What is HealthChoices?
HealthChoices Physical Health is the program through which the Commonwealth uses Physical Health Managed Care Organizations (PH-MCOs) to deliver and coordinate physical health services for most people eligible for Medical Assistance (MA).
How and When is It Expanding?
On July 1, 2012, seven of the 42 counties where HealthChoices Physical Healthdoes not currently operatewill be incorporated into existing HealthChoices zones:Bedford, Blair, Cambria and Somerset Counties will join the existing HealthChoices Southwest Zone; andFranklin, Fulton and Huntingdon Counties will join the existing HealthChoices Lehigh-Capital Zone. The ACCESS Plus Enhanced Primary Care Case Management program will end in these seven counties on July 1, 2012.
Why is It Expanding?
HealthChoices PH-MCOs have a nationally recognized track record of success:
- Access to Care– Access to primary and specialty care providers and facilities
- Better Health - Service quality and health outcomes
- Care Coordination - Integrated provider networks
What Does This Mean for MA Consumers?More Choices
Open Enrollment Period: In May 2012, everyone eligible for MA who receives physical health services through ACCESS Plus or through Voluntary Managed Care will be able to select any PH-MCO operating in the zone their county is joining:
HealthChoices Lehigh-Capital Zone PH-MCOs: / HealthChoices Southwest Zone PH-MCOsAetna Better Health
AmeriHealth Mercy Health Plan
Gateway Health Plan
United Healthcare Community Plan of PA
UPMC for You / Coventry Cares (starting 4/1/12)
Gateway Health Plan
United Healthcare Community Plan of PA
UPMC for You
Consumers currently in ACCESS Plus will move to one of the HealthChoices PH-MCOs.
Consumers currently enrolled with a voluntary PH-MCOcan choose any HealthChoices PH-MCO operating in their zone. Consumers currently enrolled with a voluntary PH-MCO who don’t want to change can stay with their plan.
What Does This Mean for MA Providers?
To serve people on MA, providers will need to join the network(s) of the HealthChoices PH-MCOs.
How Many People are Involved and Where Do They Live?
MA Recipients Eligible for HealthChoices in the Southwest Expansion Zone March 2012Current Voluntary Managed Care Plans
COUNTY / UNITED / GATEWAY / UPMC / ACCESS Plus
Bedford / 0 / 0 / 1094 / 4704
Blair / 1239 / 4852 / 0 / 12475
Cambria / 4345 / 0 / 0 / 14102
Somerset / 2139 / 0 / 0 / 5848
SWExpansion Total = 50,449 / 7723 / 4852 / 1094 / 37129
MA Recipients Eligible for HealthChoicesin the Lehigh-Capital Expansion Zone March 2012
Current Voluntary Managed Care Plan
COUNTY / UNITED / ACCESS Plus
Franklin / 2840 / 11340
Fulton / 0 / 1638
Huntingdon / 0 / 5488
Lehigh-Capital Expansion Total = 21,317 / 2840 / 18466
What’s Next?
All Eligible MA Recipientswill receive information about the HealthChoices expansion in the mail in the spring of 2012, including a toll-free phone number to speak to an enrollment assistance specialist who will help them select a PH-MCO.
Providers interested inenrolling with the HealthChoices Southwest and Lehigh-Capital PH-MCOs may find more information on the DPW website at: