PA – DHS Notifies 100,000 Medicaid Consumers in Region of Pending Changes

August 2017 ~

The Pennsylvania Department of Human Services has begun mailing flyers to about 100,000 residents in southwestern Pennsylvania. Residents in southwestern Pennsylvania eligible for Medicaid-funded long-term care services will receive notices of a major state shift affecting them in January 2018. This marks the first group of beneficiaries in the state to be transferred into the new Community HealthChoices managed care program.

Pennsylvania residents who qualify for government-funded services due to their health and income limitations will be expected to choose one of three state-contracted managed care organizations to coordinate their health and long-term care services. The MCOs will replace more limited service coordination that needy individuals have been receiving through Area Agencies on Aging or other government contractors.

The Pennsylvania Department of Human Services will continue to mail flyers to aged and disabled residents of 14 counties who will be the first in the state transferred into the new Community HealthChoices managed care program.

Medicaid beneficiaries satisfied with their current services may keep them for at least 180 days after January 1 with no changes in coordination or providers. Following this, coordination will be taken over by one of three health insurance-related MCOs that won state contracts (UPMC Community HealthChoices, PA Health & Wellness, and AmeriHealth Caritas). The MCOs will receive a fixed monthly rate from the state to organize and provide care for each consumer instead of following the existing fee-for-service system.

State officials suggest a managed care system will provide financial incentives leading to more preventive health services that avoid unnecessary hospitalizations and more home assistance that reduces nursing home use. Community HealthChoices is designed to provide more comprehensive management of all government-funded services.

“The data is pretty disturbing about how many preventable hospitalizations are out there from lack of coordination,” said Jennifer Burnett, deputy secretary of the state’s Office of Long-Term Living. Ms. Burnett said the state’s primary goal with Community HealthChoices is to better serve consumers, but considering the increase in years ahead in the state’s elderly population, “we’re hoping we can flatten the cost curve and serve more people in the community.”


Source(s): HMA Roundup; Pittsburgh Post-Gazette;