BMCO monthly physical health managed care program ......95,581 11,973 21,750 8,391 23,644 20,043...

NOTE: This report contains the number of consumers that are MA eligible and managed care eligible any time during the month. The data is based on capitation payments and therefore each consumer we paid for in the month is counted.

BMCO

Monthly Physical Health Managed Care Program Enrollment Report

Released: June 30, 2017

Table of Contents

HEALTHCHOICES

Map 4 Enrollment by Plan and by County 5-7 Market Share by Plan – Statewide 8 Market Share by Zone and by Plan 9 Enrollment by Plan, by Race and by County 10-19 Enrollment by Ethnicity, by Plan and by County 20-29 Plan Make Up by Age Group and Gender 30-32 Plan Make Up by Age Group 33-34 Aid Category Distribution 35 PCP Selection During Enrollment 36

MEDICAL ASSISTANCE TRANSPORTATION PROGRAM

All Zones 38-42

LINK TO MCO DIRECTORY 43

2

3

HealthChoices

Managed Care

Erie

Crawford

Mercer

Warren McKean Potter Tioga Bradford Susquehanna

Wayne

Pike

Lacka-wanna

Monroe

Luzerne

Wyoming

Carbon

Schuylkill

Columbia

Sullivan

Lycoming

Montour

North-umberland Snyder

Union

Juniata Mifflin

Centre

Clinton

Cameron Elk

Clearfield

Jefferson Clarion

Forest

Venango

Blair

Bedford

Huntingdon

Fulton Franklin

Somerset

Cambria

Lawrence

Beaver

Washington

Greene

Butler

Allegheny

Fayette

Westmoreland

Armstrong

Indiana

Perry

Cumberland

Adams York

Lancaster

Dauphin Lebanon

Berks

Lehigh

Northampton

Bucks

Montgomery

Chester

Delaware

Philadelphia

HC SE – 1997

HC SW – 1999

HC L/C – 2001

HC NW – 2012

HC NE – 2013 4

Mandatory May 201 7 ENROLLMENT BY PLAN AND BY COUNTY

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

09 Bucks 5,438 7,177 11,580 39,196 63,391

15 Chester 12,568 7,100 2,684 21,877 44,229

23 Delaware 9,139 11,424 8,620 68,824 98,007

46 Montgomery 9,355 11,384 12,127 53,488 86,354

51 Philadelphia 53,814 36,577 212,934 242,195 545,520

TOTAL 90,314 73,662 247,945 425,580 837,501

PERCENTAGE 11% 9% 30% 51%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

02 Allegheny 59,416 19,754 99,379 7,179 185,728

03 Armstrong 1,130 526 10,262 437 12,355

04 Beaver 11,717 2,197 13,187 1,277 28,378

05 Bedford 740 1,104 6,102 755 8,701

07 Blair 6,535 3,800 13,119 2,146 25,600

10 Butler 5,569 1,049 14,053 904 21,575

11 Cambria 3,817 5,204 14,917 2,773 26,711

26 Fayette 4,198 9,501 19,580 782 34,061

30 Greene 858 3,540 3,250 386 8,034

32 Indiana 2,599 1,833 8,973 588 13,993

37 Lawrence 7,266 1,407 8,458 769 17,900

56 Somerset 1,894 2,896 6,399 1,056 12,245

63 Washington 5,895 5,010 18,453 1,351 30,709

65 Westmoreland 11,566 7,834 31,594 2,076 53,070

TOTAL 123,200 65,655 267,726 22,479 479,060

PERCENTAGE 25% 14% 56% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17

5


cont. LEHIGH/CAPITAL

County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

01 Adams 4,088 4,707 1,176 1,203 1,468 12,642

06 Berks 15,394 8,953 6,407 6,889 40,313 77,956

21 Cumberland 12,366 3,652 3,916 1,418 5,030 26,382

22 Dauphin 28,303 10,037 7,303 3,900 5,750 55,293

28 Franklin 935 696 8,018 423 12,718 22,790

29 Fulton 147 300 731 595 719 2,492

31 Huntingdon 511 688 965 3,740 1,590 7,494

36 Lancaster 23,472 10,371 3,669 8,868 28,992 75,372

38 Lebanon 14,199 1,780 1,796 1,899 3,127 22,801

39 Lehigh 21,858 4,747 3,094 4,920 35,004 69,623

48 Northampton 13,324 2,698 2,535 2,521 23,380 44,458

50 Perry 3,674 632 643 256 923 6,128

67 York 21,853 21,242 7,017 6,542 13,765 70,419

TOTAL 160,124 70,503 47,270 43,174 172,779 493,850

PERCENTAGE 32% 14% 10% 9% 35%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

12 Cameron 855 39 129 39 1,062

16 Clarion 4,054 866 588 646 6,154

17 Clearfield 10,610 1,374 2,037 1,760 15,781

20 Crawford 12,104 1,001 1,132 1,254 15,491

24 Elk 3,543 456 266 275 4,540

25 Erie 32,176 14,688 5,954 9,851 62,669

27 Forest 528 97 74 49 748

33 Jefferson 6,812 983 356 441 8,592

42 McKean 6,222 289 1,239 754 8,504

43 Mercer 13,824 3,857 2,219 2,170 22,070

53 Potter 1,903 31 1,409 69 3,412

61 Venango 7,302 908 1,106 1,118 10,434

62 Warren 4,728 668 768 510 6,674

TOTAL 104,661 25,257 17,277 18,936 166,131

PERCENTAGE 63% 15% 10% 11%


6


cont.

NORTHEAST

County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 2,859 4,644 3,521 11,024

13 Carbon 7,014 2,732 1,150 10,896

14 Centre 2,575 6,423 2,594 11,592

18 Clinton 1,151 5,131 794 7,076

19 Columbia 1,507 7,134 1,171 9,812

34 Juniata 759 1,712 691 3,162

35 Lackawanna 6,996 29,953 5,518 42,467

40 Luzerne 16,957 43,480 9,573 70,010

41 Lycoming 4,951 15,196 1,521 21,668

44 Mifflin 2,077 4,680 1,633 8,390

45 Monroe 13,949 12,778 4,666 31,393

47 Montour 353 1,619 315 2,287

49 Northumberland 3,121 10,384 3,548 17,053

52 Pike 2,646 5,132 1,240 9,018

54 Schuylkill 8,449 14,937 3,184 26,570

55 Snyder 1,064 3,014 948 5,026

57 Sullivan 166 510 154 830

58 Susquehanna 1,118 4,619 943 6,680

59 Tioga 6,026 988 596 7,610

60 Union 922 2,750 751 4,423

64 Wayne 1,593 5,664 1,096 8,353

66 Wyoming 763 3,370 655 4,788

TOTAL 87,016 186,850 46,262 320,128

PERCENTAGE 27% 59% 14%


7

Mandatory May 201 7 MARKET SHARE BY PLAN – STATEWIDE

Total Enrollment = 2,296,670

AmeriHealth NE 87,016

4% Aetna

208,609 9%

AmeriHealth 190,056

8%

Gateway 308,581

13%

Health Partners 247,945

11%

Keystone 425,580

19%

United 226,472

10%

UPMC 415,561

18%

Geisinger 186,850

8%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17 8

Mandatory May 201 7 MARKET SHARE BY ZONE AND BY PLAN

Northwest

Aetna 18,936

11%

Gateway 25,257

15%

UPMC 104,661

63%

Ameri-Health 17,277

11%

Southeast

Aetna 73,662

9%

Health Partners 247,945

29%

Keystone 425,580

51%

United 90,314

11%

Southwest Aetna 22,479

4%

Gateway 123,200

26%

United 65,655

14%

UPMC 267,726

56%

Lehigh/Capital

Aetna 47,270

10%

Ameri-Health

172,779 35%

Gateway 160,124

32%

United 70,503

14%

UPMC 43,174

9%

Northeast

Aetna 46,262

15%

Ameri-Health NE

87,016 27%

Geisinger 186,850

58%


9

Mandatory May 201 7 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY

Southeast 09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Black or African American

42 United 618 2,482 4,657 2,157 34,342 44,256

43 Aetna 637 1,238 5,133 2,427 22,715 32,150

45 Health Partners 1,318 441 4,593 3,608 104,590 114,550

47 Keystone 3,978 3,895 33,186 12,265 149,470 202,794

Southeast MCOs 6,551 8,056 47,569 20,457 311,117 393,750

American Indian or

Alaskan Native

42 United 12 38 21 28 63 162

43 Aetna 24 40 9 55 59 187

45 Health Partners 37 13 7 39 234 330

47 Keystone 86 83 112 139 288 708

Southeast MCOs 159 174 149 261 644 1,387

Asian

42 United 227 255 624 534 3,904 5,544

43 Aetna 294 171 546 763 1,590 3,364

45 Health Partners 584 71 423 679 7,622 9,379

47 Keystone 1,346 599 4,128 3,544 18,301 27,918

Southeast MCOs 2,451 1,096 5,721 5,520 31,417 46,205

White

42 United 3,751 6,968 2,957 4,786 7,728 26,190

43 Aetna 5,325 4,517 4,710 6,361 7,045 27,958

45 Health Partners 7,686 1,748 2,554 5,780 34,251 52,019

47 Keystone 28,573 13,515 25,518 28,482 40,719 136,807

Southeast MCOs 45,335 26,748 35,739 45,409 89,743 242,974

Other or system default

42 United 531 2,101 552 1,261 6,237 10,682

43 Aetna 496 764 614 1,060 3,971 6,905

45 Health Partners 1,401 231 728 1,420 61,818 65,598

47 Keystone 3,850 2,886 4,353 6,847 28,196 46,132

Southeast MCOs 6,278 5,982 6,247 10,588 100,222 129,317

Native Hawaiian or Other

Pacific Islander

42 United 3 10 8 6 46 73

43 Aetna 5 9 12 17 30 73

45 Health Partners 20 1 7 6 135 169

47 Keystone 33 19 43 49 122 266

Southeast MCOs 61 39 70 78 333 581

Unknown

42 United 296 714 320 583 1,494 3,407

43 Aetna 396 361 400 701 1,167 3,025

45 Health Partners 534 179 308 595 4,284 5,900

47 Keystone 1,330 880 1,484 2,162 5,099 10,955

Southeast MCOs 2,556 2,134 2,512 4,041 12,044 23,287

MCO TOTAL

42 United 5,438 12,568 9,139 9,355 53,814 90,314

43 Aetna 7,177 7,100 11,424 11,384 36,577 73,662

45 Health Partners 11,580 2,684 8,620 12,127 212,934 247,945

47 Keystone 39,196 21,877 68,824 53,488 242,195 425,580

TOTAL 63,391 44,229 98,007 86,354 545,520 837,501

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17

10


Southwest 02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 07 Blair 10 Butler 11 Cambria 26 Fayette

Black or African

American

31 Gateway 28,392 31 2,773 17 454 222 483 392

32 United 8,044 10 409 13 238 29 857 875

34 UPMC 32,837 153 2,087 66 552 324 1,252 1,534

59 Aetna 2,548 5 253 13 129 19 719 79

Southwest MCOs 71,821 199 5,522 109 1,373 594 3,311 2,880

American Indian or

Alaskan Native

31 Gateway 123 2 12 0 6 4 10 8

32 United 52 2 0 1 7 1 3 9

34 UPMC 296 16 31 11 23 23 24 26

59 Aetna 21 0 3 0 5 0 3 3

Southwest MCOs 492 20 46 12 41 28 40 46

Asian

31 Gateway 840 1 29 0 18 26 5 21

32 United 403 2 16 3 24 22 13 16

34 UPMC 4,832 27 127 26 56 151 48 55

59 Aetna 181 0 16 3 11 4 11 1

Southwest MCOs 6,256 30 188 32 109 203 77 93

White

31 Gateway 27,273 1,082 8,633 703 5,967 5,187 3,230 3,691

32 United 9,976 501 1,679 1,073 3,462 941 4,190 8,430

34 UPMC 54,550 9,963 10,489 5,885 12,257 13,070 13,271 17,581

59 Aetna 3,782 427 949 730 1,958 845 1,978 668

Southwest MCOs 95,581 11,973 21,750 8,391 23,644 20,043 22,669 30,370

Other or system

default

31 Gateway 1,691 9 202 12 55 71 61 43

32 United 701 4 63 10 34 19 94 104

34 UPMC 3,768 49 257 88 112 234 182 145

59 Aetna 264 1 33 5 19 15 38 8

Southwest MCOs 6,424 63 555 115 220 339 375 300

Native Hawaiian or

Other Pacific Islander

31 Gateway 14 0 6 0 1 2 0 2

32 United 13 0 0 0 1 1 2 0

34 UPMC 64 0 3 5 6 3 2 15

59 Aetna 4 0 1 0 1 0 1 0

Southwest MCOs 95 0 10 5 9 6 5 17

Unknown

31 Gateway 1,083 5 62 8 34 57 28 41

32 United 565 7 30 4 34 36 45 67

34 UPMC 3,032 54 193 21 113 248 138 224

59 Aetna 379 4 22 4 23 21 23 23

Southwest MCOs 5,059 70 307 37 204 362 234 355

MCO TOTAL

31 Gateway 59,416 1,130 8,944 740 6,535 5,569 3,817 4,198

32 United 19,754 526 2,197 1,104 3,800 1,049 5,204 9,501

34 UPMC 99,379 10,262 13,187 6,102 13,119 14,053 14,917 19,580

59 Aetna 7,179 437 1,277 755 2,146 904 2,773 782

TOTAL 185,728 12,355 28,378 8,701 25,600 21,575 26,711 34,061


11


Southwest cont.

30 Greene 32 Indiana 37 Lawrence 56 Somerset 63 Washington 65 Westmoreland Southwest

Black or African

American

31 Gateway 16 95 960 17 694 1,471 36,017

32 United 37 91 194 24 555 777 12,153

34 UPMC 44 251 869 55 1,622 2,118 43,764

59 Aetna 9 44 133 20 157 169 4,297

Southwest MCOs 106 481 2,156 116 3,028 4,535 96,231

American Indian or

Alaskan Native

31 Gateway 3 2 7 2 6 24 209

32 United 4 4 1 2 10 16 112

34 UPMC 5 9 13 13 32 52 574

59 Aetna 1 2 2 2 3 3 48

Southwest MCOs 13 17 23 19 51 95 943

Asian

31 Gateway 2 26 15 5 22 35 1,045

32 United 4 4 3 3 14 33 560

34 UPMC 10 67 39 20 115 224 5,797

59 Aetna 4 6 2 2 6 21 268

Southwest MCOs 20 103 59 30 157 313 7,670

White

31 Gateway 826 2,415 6,193 1,837 5,018 9,731 81,786

32 United 3,475 1,692 1,181 2,829 4,272 6,742 50,443

34 UPMC 3,145 8,443 7,394 6,208 16,029 28,114 206,399

59 Aetna 363 507 616 1,000 1,117 1,791 16,731

Southwest MCOs 7,809 13,057 15,384 11,874 26,436 46,378 355,359

Other or system

default

31 Gateway 8 33 40 22 70 164 2,481

32 United 11 18 18 20 78 135 1,309

34 UPMC 25 88 67 39 264 436 5,754

59 Aetna 3 15 8 12 18 40 479

Southwest MCOs 47 154 133 93 430 775 10,023

Native Hawaiian or


31 Gateway 0 0 1 1 0 3 30

32 United 0 1 1 0 4 2 25

34 UPMC 3 3 2 0 8 9 123

59 Aetna 0 0 0 0 0 1 8

Southwest MCOs 3 4 4 1 12 15 186

Unknown

31 Gateway 3 28 50 10 85 138 1,632

32 United 9 23 9 18 77 129 1,053

34 UPMC 18 112 74 64 383 641 5,315

59 Aetna 6 14 8 20 50 51 648

Southwest MCOs 36 177 141 112 595 959 8,648

MCO TOTAL

31 Gateway 858 2,599 7,266 1,894 5,895 11,566 123,200

32 United 3,540 1,833 1,407 2,896 5,010 7,834 65,655

34 UPMC 3,250 8,973 8,458 6,399 18,453 31,594 267,726

59 Aetna 386 588 769 1,056 1,351 2,076 22,479

TOTAL 8,034 13,993 17,900 12,245 30,709 53,070 479,060


12


Lehigh/Capital 01 Adams 06 Berks 21 Cumberland 22 Dauphin 28 Franklin 29 Fulton 31 Huntingdon

Black or African

American

51 Gateway 147 1,455 1,424 11,082 80 2 24

52 United 241 793 481 3,707 54 6 29

53 Aetna 57 721 392 2,305 684 14 50

54 UPMC 48 588 117 1,159 43 6 115

57 AmeriHealth 77 3,437 513 1,770 1,082 17 47

Lehigh/Capital MCOs 570 6,994 2,927 20,023 1,943 45 265

American Indian or

Alaskan Native

51 Gateway 18 18 34 75 4 1 0

52 United 12 16 12 26 2 0 0

53 Aetna 7 10 10 30 14 2 0

54 UPMC 1 13 3 8 3 2 8

57 AmeriHealth 2 43 8 24 34 3 1

Lehigh/Capital MCOs 40 100 67 163 57 8 9

Asian

51 Gateway 32 176 323 1,425 10 0 1

52 United 39 142 135 471 2 0 1

53 Aetna 5 126 122 272 47 1 4

54 UPMC 14 68 37 166 2 1 15

57 AmeriHealth 10 299 113 170 104 0 3

Lehigh/Capital MCOs 100 811 730 2,504 165 2 24

White

51 Gateway 3,584 7,220 8,875 8,800 728 140 472

52 United 3,716 5,141 2,418 3,647 578 291 643

53 Aetna 979 3,829 2,887 3,426 6,400 698 899

54 UPMC 1,010 4,096 1,055 1,877 341 585 3,531

57 AmeriHealth 1,251 13,851 3,753 2,391 9,434 682 1,513

Lehigh/Capital MCOs 10,540 34,137 18,988 20,141 17,481 2,396 7,058

Other or system

default

51 Gateway 198 6,145 1,268 5,897 76 0 13

52 United 551 2,560 429 1,726 39 3 11

53 Aetna 79 1,474 289 915 588 13 8

54 UPMC 74 1,831 142 488 12 0 49

57 AmeriHealth 76 21,671 432 1,053 1,407 13 15


Native Hawaiian or


51 Gateway 2 3 9 23 0 0 0

52 United 2 13 3 10 1 0 0

53 Aetna 1 3 9 6 7 0 0

54 UPMC 1 5 4 3 2 1 1

57 AmeriHealth 0 24 6 8 11 1 2


Unknown

51 Gateway 107 377 433 1,001 37 4 1

52 United 146 288 174 450 20 0 4

53 Aetna 48 244 207 349 278 3 4

54 UPMC 55 288 60 199 20 0 21

57 AmeriHealth 52 988 205 334 646 3 9


MCO TOTAL

51 Gateway 4,088 15,394 12,366 28,303 935 147 511

52 United 4,707 8,953 3,652 10,037 696 300 688

53 Aetna 1,176 6,407 3,916 7,303 8,018 731 965

54 UPMC 1,203 6,889 1,418 3,900 423 595 3,740

57 AmeriHealth 1,468 40,313 5,030 5,750 12,718 719 1,590

TOTAL 12,642 77,956 26,382 55,293 22,790 2,492 7,494

Racial/Ethnic

information is self-

reported by consumers.


13


Lehigh/Capital cont. 36 Lancaster 38 Lebanon 39 Lehigh 48 Northampton 50 Perry 67 York Lehigh/Capital

Black or African

American

51 Gateway 1,958 613 3,043 1,910 44 2,449 24,231

52 United 1,251 113 715 332 12 3,861 11,595

53 Aetna 420 78 525 349 24 1,085 6,704

54 UPMC 793 135 690 280 7 898 4,879

57 AmeriHealth 3,259 182 3,956 2,500 13 2,222 19,075

Lehigh/Capital MCOs 7,681 1,121 8,929 5,371 100 10,515 66,484

American Indian or

Alaskan Native

51 Gateway 35 13 34 35 2 72 341

52 United 25 1 18 5 0 50 167

53 Aetna 18 2 3 14 1 28 139

54 UPMC 34 7 10 7 2 20 118

57 AmeriHealth 52 4 46 52 0 54 323

Lehigh/Capital MCOs 164 27 111 113 5 224 1,088

Asian

51 Gateway 978 116 315 212 9 208 3,805

52 United 284 23 111 58 2 247 1,515

53 Aetna 109 17 81 63 6 110 963

54 UPMC 293 15 157 67 1 84 920

57 AmeriHealth 701 59 599 466 1 166 2,691

Lehigh/Capital MCOs 2,365 230 1,263 866 19 815 9,894

White

51 Gateway 15,001 9,692 15,336 7,768 3,509 15,922 97,047

52 United 5,872 1,276 3,206 1,821 587 12,115 41,311

53 Aetna 2,226 1,303 2,075 1,726 588 4,668 31,704

54 UPMC 5,696 1,307 3,366 1,704 229 4,426 29,223

57 AmeriHealth 14,857 1,734 25,670 15,064 872 8,301 99,373



51 Gateway 4,529 3,370 2,720 3,067 80 2,678 30,041

52 United 2,438 305 500 357 16 4,391 13,326

53 Aetna 645 322 301 279 12 837 5,762

54 UPMC 1,447 350 498 312 12 847 6,062

57 AmeriHealth 8,697 1,010 4,011 4,686 25 2,547 45,643


Native Hawaiian or


51 Gateway 8 8 12 9 0 17 91

52 United 10 2 21 5 1 20 88

53 Aetna 4 1 5 4 0 5 45

54 UPMC 5 1 14 13 0 4 54

57 AmeriHealth 26 5 29 20 0 17 149


Unknown

51 Gateway 963 387 398 323 30 507 4,568

52 United 491 60 176 120 14 558 2,501

53 Aetna 247 73 104 100 12 284 1,953

54 UPMC 600 84 185 138 5 263 1,918

57 AmeriHealth 1,400 133 693 592 12 458 5,525

Lehigh/Capital MCOs 3,701 737 1,556 1,273 73 2,070 16,465

MCO TOTAL

51 Gateway 23,472 14,199 21,858 13,324 3,674 21,853 160,124

52 United 10,371 1,780 4,747 2,698 632 21,242 70,503

53 Aetna 3,669 1,796 3,094 2,535 643 7,017 47,270

54 UPMC 8,868 1,899 4,920 2,521 256 6,542 43,174

57 AmeriHealth 28,992 3,127 35,004 23,380 923 13,765 172,779

TOTAL 75,372 22,801 69,623 44,458 6,128 70,419 493,850

Racial/Ethnic information is

self-reported by consumers.


14


Northwest 12 Cameron 16 Clarion 17 Clearfield 20 Crawford 24 Elk 25 Erie 27 Forest


35 UPMC 20 77 111 408 37 4,927 2

36 Gateway 0 17 33 36 6 3,679 1

37 AmeriHealth 7 16 31 30 5 1,324 0

56 Aetna 0 32 19 48 2 2,377 1

New West MCOs 27 142 194 522 50 12,307 4

American Indian or Alaskan

Native

35 UPMC 1 3 7 19 12 96 2

36 Gateway 0 1 0 2 0 34 4

37 AmeriHealth 0 2 6 2 1 11 0

56 Aetna 1 2 0 4 0 45 1

New West MCOs 2 8 13 27 13 186 7

Asian

35 UPMC 8 10 45 37 6 1,435 0

36 Gateway 0 5 2 0 2 241 0

37 AmeriHealth 2 3 10 2 0 175 0

56 Aetna 0 2 7 2 0 111 0

New West MCOs 10 20 64 41 8 1,962 0

White

35 UPMC 819 3,895 10,337 11,473 3,458 23,770 519

36 Gateway 39 830 1,323 946 446 9,690 92

37 AmeriHealth 119 557 1,963 1,075 258 4,096 74

56 Aetna 38 603 1,706 1,186 268 6,672 46

New West MCOs 1,015 5,885 15,329 14,680 4,430 44,228 731


35 UPMC 5 21 52 80 15 1,564 4

36 Gateway 0 6 9 7 1 916 0

37 AmeriHealth 1 5 10 11 1 285 0

56 Aetna 0 2 10 3 3 550 1

New West MCOs 6 34 81 101 20 3,315 5


Pacific Islander

35 UPMC 0 1 0 1 0 19 0

36 Gateway 0 0 0 3 0 7 0

37 AmeriHealth 0 0 0 0 0 2 0

56 Aetna 0 1 1 2 0 4 0

New West MCOs 0 2 1 6 0 32 0

Unknown

35 UPMC 2 47 58 86 15 365 1

36 Gateway 0 7 7 7 1 121 0

37 AmeriHealth 0 5 17 12 1 61 0

56 Aetna 0 4 17 9 2 92 0

New West MCOs 2 63 99 114 19 639 1

MCO TOTAL

35 UPMC 855 4,054 10,610 12,104 3,543 32,176 528

36 Gateway 39 866 1,374 1,001 456 14,688 97

37 AmeriHealth 129 588 2,037 1,132 266 5,954 74

56 Aetna 39 646 1,760 1,254 275 9,851 49

TOTAL 1,062 6,154 15,781 15,491 4,540 62,669 748


15


Northwest cont.

33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren New West


35 UPMC 69 60 1,761 15 194 37 7,718

36 Gateway 8 8 695 0 30 6 4,519

37 AmeriHealth 7 4 449 15 31 7 1,926

56 Aetna 5 6 431 0 37 6 2,964

New West MCOs 89 78 3,336 30 292 56 17,127

American Indian or

Alaskan Native

35 UPMC 6 19 13 5 11 16 210

36 Gateway 1 2 4 0 6 1 55

37 AmeriHealth 1 5 5 1 3 0 37

56 Aetna 3 4 4 0 2 3 69

New West MCOs 11 30 26 6 22 20 371

Asian

35 UPMC 14 17 86 1 23 13 1,695

36 Gateway 2 0 18 0 4 0 274

37 AmeriHealth 1 11 12 1 5 2 224

56 Aetna 0 1 13 0 1 2 139

New West MCOs 17 29 129 2 33 17 2,332

White

35 UPMC 6,671 6,072 11,627 1,858 6,979 4,618 92,096

36 Gateway 968 276 3,067 31 848 655 19,211

37 AmeriHealth 343 1,204 1,687 1,377 1,054 754 14,561

56 Aetna 427 740 1,666 68 1,061 490 14,971

New West MCOs 8,409 8,292 18,047 3,334 9,942 6,517 140,839


35 UPMC 27 35 173 10 50 25 2,061

36 Gateway 4 3 36 0 10 1 993

37 AmeriHealth 2 9 34 9 8 2 377

56 Aetna 3 2 23 0 11 6 614

New West MCOs 36 49 266 19 79 34 4,045


Pacific Islander

35 UPMC 1 3 4 1 2 1 33

36 Gateway 0 0 2 0 1 0 13

37 AmeriHealth 0 2 1 1 1 1 8

56 Aetna 0 0 0 0 0 0 8

New West MCOs 1 5 7 2 4 2 62

Unknown

35 UPMC 24 16 160 13 43 18 848

36 Gateway 0 0 35 0 9 5 192

37 AmeriHealth 2 4 31 5 4 2 144

56 Aetna 3 1 33 1 6 3 171

New West MCOs 29 21 259 19 62 28 1,355

MCO TOTAL

35 UPMC 6,812 6,222 13,824 1,903 7,302 4,728 104,661

36 Gateway 983 289 3,857 31 908 668 25,257

37 AmeriHealth 356 1,239 2,219 1,409 1,106 768 17,277

56 Aetna 441 754 2,170 69 1,118 510 18,936

TOTAL 8,592 8,504 22,070 3,412 10,434 6,674 166,131


16


Northeast

08 Bradford 13 Carbon 14 Centre 18 Clinton 19 Columbia 34 Juniata 35 Lackawanna 40 Luzerne


41 AmeriHealth NE 42 197 123 16 76 12 791 1,896

44 Geisinger 62 87 243 79 222 24 2,381 4,276

50 Aetna 55 71 153 36 74 10 634 1,293

New East MCOs 159 355 519 131 372 46 3,806 7,465


Native

41 AmeriHealth NE 9 11 5 2 7 3 13 31

44 Geisinger 5 6 25 6 12 4 62 49

50 Aetna 3 4 14 0 4 1 7 11

New East MCOs 17 21 44 8 23 8 82 91

Asian

41 AmeriHealth NE 16 15 65 6 8 1 191 111

44 Geisinger 26 14 155 14 46 7 991 380

50 Aetna 6 5 103 1 15 4 205 82

New East MCOs 48 34 323 21 69 12 1,387 573

White

41 AmeriHealth NE 2,748 6,470 2,287 1,105 1,356 673 4,925 9,973

44 Geisinger 4,499 2,482 5,815 4,920 6,673 1,534 22,209 30,750

50 Aetna 3,415 1,000 2,204 731 1,028 625 3,909 6,333

New East MCOs 10,662 9,952 10,306 6,756 9,057 2,832 31,043 47,056


41 AmeriHealth NE 21 225 57 12 42 55 939 4,698

44 Geisinger 25 95 81 54 109 123 3,727 7,385

50 Aetna 19 44 54 9 32 42 620 1,691

New East MCOs 65 364 192 75 183 220 5,286 13,774


Pacific Islander

41 AmeriHealth NE 1 0 1 0 1 0 2 6

44 Geisinger 0 0 2 0 1 0 12 26

50 Aetna 0 1 3 0 1 0 9 7

New East MCOs 1 1 6 0 3 0 23 39

Unknown

41 AmeriHealth NE 22 96 37 10 17 15 135 242

44 Geisinger 27 48 102 58 71 20 571 614

50 Aetna 23 25 63 17 17 9 134 156

New East MCOs 72 169 202 85 105 44 840 1,012

MCO TOTAL

41 AmeriHealth NE 2,859 7,014 2,575 1,151 1,507 759 6,996 16,957

44 Geisinger 4,644 2,732 6,423 5,131 7,134 1,712 29,953 43,480

50 Aetna 3,521 1,150 2,594 794 1,171 691 5,518 9,573

TOTAL 11,024 10,896 11,592 7,076 9,812 3,162 42,467 70,010

Racial/Ethnic information is self-reported by consumers.


17


Northeast cont.

41 Lycoming 44 Mifflin 45 Monroe 47 Montour 49 Northumberland 52 Pike 54 Schuylkill 55 Snyder


41 AmeriHealth NE 868 44 2,360 12 169 305 346 40

44 Geisinger 2,123 82 2,324 45 401 344 502 93

50 Aetna 224 38 1,064 14 189 113 126 21

New East MCOs 3,215 164 5,748 71 759 762 974 154

American Indian or

Alaskan Native

41 AmeriHealth NE 6 3 31 0 8 11 12 0

44 Geisinger 30 4 49 5 16 12 21 5

50 Aetna 1 0 14 1 6 8 1 1

New East MCOs 37 7 94 6 30 31 34 6

Asian

41 AmeriHealth NE 15 7 174 4 8 23 40 20

44 Geisinger 73 15 208 17 41 57 73 11

50 Aetna 11 11 59 5 9 6 17 5

New East MCOs 99 33 441 26 58 86 130 36

White

41 AmeriHealth NE 3,952 1,994 8,612 319 2,717 1,955 7,502 977

44 Geisinger 12,711 4,490 7,605 1,496 9,429 4,280 13,592 2,802

50 Aetna 1,243 1,547 2,506 284 3,177 948 2,883 889

New East MCOs 17,906 8,031 18,723 2,099 15,323 7,183 23,977 4,668


41 AmeriHealth NE 70 23 2,293 15 192 294 461 21

44 Geisinger 156 74 2,159 34 358 322 587 64

50 Aetna 19 30 828 5 130 129 123 13

New East MCOs 245 127 5,280 54 680 745 1,171 98


Pacific Islander

41 AmeriHealth NE 4 2 30 0 0 0 1 0

44 Geisinger 6 2 8 3 5 7 10 2

50 Aetna 0 4 5 0 3 0 1 0

New East MCOs 10 8 43 3 8 7 12 2

Unknown

41 AmeriHealth NE 36 4 449 3 27 58 87 6

44 Geisinger 97 13 425 19 134 110 152 37

50 Aetna 23 3 190 6 34 36 33 19

New East MCOs 156 20 1,064 28 195 204 272 62

MCO TOTAL

41 AmeriHealth NE 4,951 2,077 13,949 353 3,121 2,646 8,449 1,064

44 Geisinger 15,196 4,680 12,778 1,619 10,384 5,132 14,937 3,014

50 Aetna 1,521 1,633 4,666 315 3,548 1,240 3,184 948

TOTAL 21,668 8,390 31,393 2,287 17,053 9,018 26,570 5,026



18


Northeast cont.

57 Sullivan 58 Susquehanna 59 Tioga 60 Union 64 Wayne 66 Wyoming New East


41 AmeriHealth NE 1 3 88 48 43 9 7,489

44 Geisinger 4 30 17 197 103 34 13,673

50 Aetna 5 12 19 45 33 7 4,236

New East MCOs 10 45 124 290 179 50 25,398


Native

41 AmeriHealth NE 1 0 13 0 3 0 169

44 Geisinger 1 2 4 4 22 4 348

50 Aetna 0 0 1 1 5 0 83

New East MCOs 2 2 18 5 30 4 600

Asian

41 AmeriHealth NE 1 3 18 3 14 3 746

44 Geisinger 0 15 6 20 30 14 2,213

50 Aetna 0 2 0 0 6 2 554

New East MCOs 1 20 24 23 50 19 3,513

White

41 AmeriHealth NE 158 1,094 5,845 838 1,482 737 67,719

44 Geisinger 501 4,513 934 2,428 5,351 3,272 152,286

50 Aetna 145 920 563 687 1,005 635 36,677

New East MCOs 804 6,527 7,342 3,953 7,838 4,644 256,682


41 AmeriHealth NE 3 15 38 25 35 10 9,544

44 Geisinger 4 29 9 77 97 18 15,587

50 Aetna 2 7 8 10 30 7 3,852

New East MCOs 9 51 55 112 162 35 28,983


Pacific Islander

41 AmeriHealth NE 0 0 2 0 1 1 52

44 Geisinger 0 0 0 0 2 0 86

50 Aetna 0 0 0 0 1 0 35

New East MCOs 0 0 2 0 4 1 173

Unknown

41 AmeriHealth NE 2 3 22 8 15 3 1,297

44 Geisinger 0 30 18 24 59 28 2,657

50 Aetna 2 2 5 8 16 4 825

New East MCOs 4 35 45 40 90 35 4,779

MCO TOTAL

41 AmeriHealth NE 166 1,118 6,026 922 1,593 763 87,016 44 Geisinger 510 4,619 988 2,750 5,664 3,370 186,850 50 Aetna 154 943 596 751 1,096 655 46,262

TOTAL 830 6,680 7,610 4,423 8,353 4,788 320,128



19

Mandatory May 201 7 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 45 57 44 58 172 376

43 Aetna 42 31 38 59 135 305

45 Health Partners 40 45 36 62 237 420

47 Keystone 116 47 86 193 340 782

Southeast MCOs 243 180 204 372 884 1,883

Non-Hispanic

42 United 4,833 9,287 8,635 8,067 47,701 78,523

43 Aetna 6,585 5,931 10,824 10,460 32,515 66,315

45 Health Partners 10,022 2,353 7,910 10,820 146,667 177,772

47 Keystone 34,946 17,813 65,144 47,388 215,387 380,678

Southeast MCOs 56,386 35,384 92,513 76,735 442,270 703,288

Hispanic

42 United 560 3,224 460 1,230 5,941 11,415

43 Aetna 550 1,138 562 865 3,927 7,042

45 Health Partners 1,518 286 674 1,245 66,030 69,753

47 Keystone 4,134 4,017 3,594 5,907 26,468 44,120

Southeast MCOs 6,762 8,665 5,290 9,247 102,366 132,330

TOTAL 63,391 44,229 98,007 86,354 545,520 837,501



20


Southwest

02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 07 Blair 10 Butler 11 Cambria 26 Fayette

Other/Unknown

31 Gateway 88 1 4 0 11 13 4 7

32 United 74 2 6 1 1 6 8 6

34 UPMC 309 11 17 6 24 35 19 32

59 Aetna 45 4 2 2 4 9 2 1

Southwest MCOs 516 18 29 9 40 63 33 46

Non-Hispanic

31 Gateway 58,510 1,116 11,574 735 6,447 5,452 3,753 4,157

32 United 19,294 523 2,145 1,097 3,747 1,008 5,105 9,409

34 UPMC 96,942 10,186 12,994 6,018 12,946 13,756 14,753 19,381

59 Aetna 6,940 431 1,246 747 2,108 878 2,737 770

Southwest MCOs 181,686 12,256 27,959 8,597 25,248 21,094 26,348 33,717

Hispanic

31 Gateway 818 13 139 5 77 104 60 34

32 United 386 1 46 6 52 35 91 86

34 UPMC 2,128 65 176 78 149 262 145 167

59 Aetna 194 2 29 6 34 17 34 11

Southwest MCOs 3,526 81 390 95 312 418 330 298

TOTAL 185,728 12,355 28,378 8,701 25,600 21,575 26,711 34,061



21


Southwest cont.

30 Greene 32 Indiana 37 Lawrence 56 Somerset 63 Washington 65 Westmoreland Southwest

Other/Unknown

31 Gateway 3 2 1 2 11 14 161

32 United 3 12 1 2 4 21 147

34 UPMC 4 22 5 6 32 50 572

59 Aetna 2 4 0 0 9 9 93

Southwest MCOs 12 40 7 10 56 94 973

Non-Hispanic

31 Gateway 849 2,575 7,215 1,870 5,807 11,442 121,502

32 United 3,520 1,798 1,389 2,869 4,932 7,714 64,550

34 UPMC 3,224 8,857 8,353 6,332 18,166 31,201 263,109

59 Aetna 382 564 763 1,040 1,315 2,029 21,950

Southwest MCOs 7,975 13,794 17,720 12,111 30,220 52,386 471,111

Hispanic

31 Gateway 6 22 50 22 77 110 1,537

32 United 17 23 17 25 74 99 958

34 UPMC 22 94 100 61 255 343 4,045

59 Aetna 2 20 6 16 27 38 436

Southwest MCOs 47 159 173 124 433 590 6,976

TOTAL 8,034 13,993 17,900 12,245 30,709 53,070 479,060



22


Lehigh/Capital

01 Adams 06 Berks 21 Cumberland 22 Dauphin 28 Franklin 29 Fulton 31 Huntingdon

Other/Unknown

51 Gateway 4 17 28 37 6 4 4

52 United 12 19 18 47 2 0 0

53 Aetna 6 26 24 24 14 0 0

54 UPMC 3 23 9 19 8 1 3

57 AmeriHealth 3 44 24 18 47 1 0


Non-Hispanic

51 Gateway 3,785 8,406 11,514 22,219 854 141 498

52 United 3,775 6,072 3,289 8,362 649 297 674

53 Aetna 1,041 4,722 3,653 6,455 7,397 715 954

54 UPMC 1,053 4,749 1,311 3,448 398 590 3,703

57 AmeriHealth 1,324 16,083 4,628 4,587 10,822 707 1,581


Hispanic

51 Gateway 299 6,971 824 6,047 75 2 9

52 United 920 2,862 345 1,628 45 3 14

53 Aetna 129 1,659 239 824 607 16 11

54 UPMC 147 2,117 98 433 17 4 34

57 AmeriHealth 141 24,186 378 1,145 1,849 11 9

Lehigh/Capital MCOs 1,636 37,795 1,884 10,077 2,593 36 77

TOTAL 12,642 77,956 26,382 55,293 22,790 2,492 7,494



23

Mandatory May 2017 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY

Lehigh/Capital cont.

36 Lancaster 38 Lebanon 39 Lehigh 48 Northampton 50 Perry 67 York Lehigh/Capital

Other/Unknown

51 Gateway 37 10 27 27 4 38 243

52 United 23 9 17 14 5 48 214

53 Aetna 13 5 14 21 1 27 175

54 UPMC 55 4 24 22 0 20 191

57 AmeriHealth 64 6 79 57 3 35 381

Lehigh/Capital MCOs 192 34 161 141 13 168 1,204

Non-Hispanic

51 Gateway 18,384 9,386 10,185 8,896 3,571 19,014 116,853

52 United 7,509 1,327 2,712 2,234 610 16,231 53,741

53 Aetna 2,909 1,350 1,953 2,100 629 6,084 39,962

54 UPMC 7,081 1,372 3,207 1,992 247 5,538 34,689

57 AmeriHealth 18,553 1,721 17,862 16,567 903 10,692 106,030


Hispanic

51 Gateway 5,051 4,803 11,646 4,401 99 2,801 43,028

52 United 2,839 444 2,018 450 17 4,963 16,548

53 Aetna 747 441 1,127 414 13 906 7,133

54 UPMC 1,732 523 1,689 507 9 984 8,294

57 AmeriHealth 10,375 1,400 17,063 6,756 17 3,038 66,368


TOTAL 75,372 22,801 69,623 44,458 6,128 70,419 493,850



24


Northwest

12 Cameron 16 Clarion 17 Clearfield 20 Crawford 24 Elk 25 Erie 27 Forest

Other/Unknown

35 UPMC 0 4 4 13 1 38 1

36 Gateway 0 1 0 0 0 8 0

37 AmeriHealth 0 2 0 4 0 5 0

56 Aetna 0 0 1 6 0 4 0

New West MCOs 0 7 5 23 1 55 1

Non-Hispanic

35 UPMC 836 4,020 10,530 11,955 3,509 30,223 526

36 Gateway 38 864 1,367 993 455 13,386 93

37 AmeriHealth 128 581 2,008 1,119 257 5,568 74

56 Aetna 38 638 1,736 1,233 270 9,105 49

New West MCOs 1,040 6,103 15,641 15,300 4,491 58,282 742

Hispanic

35 UPMC 19 30 76 136 33 1,915 1

36 Gateway 1 1 7 8 1 1,294 4

37 AmeriHealth 1 5 29 9 9 381 0

56 Aetna 1 8 23 15 5 742 0

New West MCOs 22 44 135 168 48 4,332 5

TOTAL 1,062 6,154 15,781 15,491 4,540 62,669 748



25


Northwest cont.

33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren New West

Other/Unknown

35 UPMC 6 1 42 4 6 10 130

36 Gateway 1 0 8 0 2 0 20

37 AmeriHealth 0 0 17 1 1 1 31

56 Aetna 2 0 4 0 1 3 21

New West MCOs 9 1 71 5 10 14 202

Non-Hispanic

35 UPMC 6,737 6,138 13,622 1,882 7,212 4,697 101,887

36 Gateway 975 285 3,816 30 894 654 23,850

37 AmeriHealth 356 1,231 2,170 1,400 1,091 764 16,747

56 Aetna 438 753 2,139 68 1,105 505 18,077

New West MCOs 8,506 8,407 21,747 3,380 10,302 6,620 160,561

Hispanic

35 UPMC 69 83 160 17 84 21 2,644

36 Gateway 7 4 33 1 12 14 1,387

37 AmeriHealth 0 8 32 8 14 3 499

56 Aetna 1 1 27 1 12 2 838

New West MCOs 77 96 252 27 122 40 5,368

TOTAL 8,592 8,504 22,070 3,412 10,434 6,674 166,131



26


Northeast

08 Bradford 13 Carbon 14 Centre 18 Clinton 19 Columbia 34 Juniata 35 Lackawanna 40 Luzerne

Other/Unknown

41 AmeriHealth NE 7 7 14 2 2 2 15 27

44 Geisinger 5 8 29 10 10 3 64 68

50 Aetna 6 4 21 2 2 2 18 23

New East MCOs 18 19 64 14 14 7 97 118

Non-Hispanic

41 AmeriHealth NE 2,808 6,483 2,491 1,133 1,426 695 5,758 11,447

44 Geisinger 4,584 2,554 6,269 5,051 6,890 1,574 25,237 34,551

50 Aetna 3,496 1,070 2,493 777 1,108 640 4,670 7,475

New East MCOs 10,888 10,107 11,253 6,961 9,424 2,909 35,665 53,473

Hispanic

41 AmeriHealth NE 44 524 70 16 79 62 1,223 5,483

44 Geisinger 55 170 125 70 234 135 4,652 8,861

50 Aetna 19 76 80 15 61 49 830 2,075

New East MCOs 118 770 275 101 374 246 6,705 16,419

TOTAL 11,024 10,896 11,592 7,076 9,812 3,162 42,467 70,010




Northeast cont.

41 Lycoming 44 Mifflin 45 Monroe 47 Montour 49 Northumberland 52 Pike 54 Schuylkill 55 Snyder

Other/Unknown

41 AmeriHealth NE 10 1 24 0 3 12 6 2

44 Geisinger 15 0 30 1 9 25 7 7

50 Aetna 7 0 14 1 2 7 5 4

New East MCOs 32 1 68 2 14 44 18 13

Non-Hispanic

41 AmeriHealth NE 4,845 2,025 11,378 329 2,820 2,191 7,632 1,022

44 Geisinger 14,953 4,548 10,332 1,572 9,741 4,602 13,853 2,913

50 Aetna 1,483 1,559 3,678 311 3,347 1,031 2,976 924

New East MCOs 21,281 8,132 25,388 2,212 15,908 7,824 24,461 4,859

Hispanic

41 AmeriHealth NE 96 51 2,547 24 298 443 811 40

44 Geisinger 228 132 2,416 46 634 505 1,077 94

50 Aetna 31 74 974 3 199 202 203 20

New East MCOs 355 257 5,937 73 1,131 1,150 2,091 154

TOTAL 21,668 8,390 31,393 2,287 17,053 9,018 26,570 5,026



28


Northeast cont.

57 Sullivan 58 Susquehanna 59 Tioga 60 Union 64 Wayne 66 Wyoming New East

Other/Unknown

41 AmeriHealth NE 0 0 2 1 5 1 143

44 Geisinger 1 8 0 8 12 6 326

50 Aetna 0 1 1 1 4 3 128

New East MCOs 1 9 3 10 21 10 597

Non-Hispanic

41 AmeriHealth NE 158 1,104 5,981 853 1,525 751 74,855

44 Geisinger 497 4,534 977 2,569 5,418 3,312 166,531

50 Aetna 151 924 588 714 1,038 644 41,097

New East MCOs 806 6,562 7,546 4,136 7,981 4,707 282,483

Hispanic

41 AmeriHealth NE 8 14 43 68 63 11 12,018

44 Geisinger 12 77 11 173 234 52 19,993

50 Aetna 3 18 7 36 54 8 5,037

New East MCOs 23 109 61 277 351 71 37,048

TOTAL 830 6,680 7,610 4,423 8,353 4,788 320,128



29

Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP AND GENDER

SOUTHEAST

42 United 43 Aetna 45 Health

Partners 47 Keystone TOTAL

< 21 Yrs

Female 22,139 17,875 59,846 113,815 213,675

Male 22,959 19,042 60,846 121,611 224,458

Total 45,098 36,917 120,692 235,426 438,133

22-45 Yrs

Female 16,765 13,608 51,904 78,872 161,149

Male 13,814 12,896 29,661 45,062 101,433

Total 30,579 26,504 81,565 123,934 262,582

46-64 Yrs

Female 6,794 4,341 24,351 34,779 70,265

Male 7,214 5,469 19,799 28,961 61,443

Total 14,008 9,810 44,150 63,740 131,708

Over 64

Yrs

Female 372 284 965 1,551 3,172

Male 257 147 573 929 1,906

Total 629 431 1,538 2,480 5,078

TOTAL 90,314 73,662 247,945 425,580 837,501

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs

Female 31,845 16,657 63,210 4,701 116,413

Male 34,067 17,829 66,865 4,835 123,596

Total 65,912 34,486 130,075 9,536 240,009

22-45 Yrs

Female 24,298 12,286 54,624 4,614 95,822

Male 13,673 8,957 34,234 4,457 61,321

Total 37,971 21,243 88,858 9,071 157,143

46-64 Yrs

Female 10,871 5,110 26,689 1,756 44,426

Male 8,196 4,684 21,392 2,056 36,328

Total 19,067 9,794 48,081 3,812 80,754

Over 64

Yrs

Female 153 77 434 31 695

Male 97 55 278 29 459

Total 250 132 712 60 1,154

TOTAL 123,200 65,655 267,726 22,479 479,060



LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57

AmeriHealth TOTAL

< 21 Yrs

Female 45,909 20,030 11,691 10,264 47,819 135,713

Male 48,318 20,972 12,162 11,129 50,286 142,867

Total 94,227 41,002 23,853 21,393 98,105 278,580

22-45

Yrs

Female 30,848 12,809 9,773 9,059 34,120 96,609

Male 14,959 7,818 7,027 6,153 16,769 52,726

Total 45,807 20,627 16,800 15,212 50,889 149,335

46-64

Yrs

Female 11,332 4,722 3,283 3,435 13,767 36,539

Male 8,111 3,885 3,142 2,965 9,239 27,342

Total 19,443 8,607 6,425 6,400 23,006 63,881

Over 64

Yrs

Female 427 166 125 96 522 1,336

Male 220 101 67 73 257 718

Total 647 267 192 169 779 2,054

TOTAL 160,124 70,503 47,270 43,174 172,779 493,850

NORTHWEST

35 UPMC 36 Gateway 37

AmeriHealth 56 Aetna TOTAL

< 21 Yrs

Female 26,554 6,388 3,906 4,805 41,653

Male 28,383 6,716 4,077 4,966 44,142

Total 54,937 13,104 7,983 9,771 85,795

22-45 Yrs

Female 20,750 5,005 3,563 3,646 32,964

Male 12,716 3,468 2,781 2,778 21,743

Total 33,466 8,473 6,344 6,424 54,707

46-64 Yrs

Female 9,287 1,991 1,468 1,465 14,211

Male 6,785 1,658 1,455 1,240 11,138

Total 16,072 3,649 2,923 2,705 25,349

Over 64

Yrs

Female 110 20 18 15 163

Male 76 11 9 21 117

Total 186 31 27 36 280

TOTAL 104,661 25,257 17,277 18,936 166,131


31


NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs Female 22,084 47,769 11,547 81,400

Male 23,050 50,294 12,298 85,642

Total 45,134 98,063 23,845 167,042

22-45 Yrs Female 17,890 37,426 9,087 64,403

Male 10,658 21,658 6,677 38,993

Total 28,548 59,084 15,764 103,396

46-64 Yrs Female 7,378 16,732 3,560 27,670

Male 5,695 12,498 2,961 21,154

Total 13,073 29,230 6,521 48,824

Over 64 Yrs Female 172 297 84 553

Male 89 176 48 313

Total 261 473 132 866

TOTAL 87,016 186,850 46,262 320,128


Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs 45,098 36,917 120,692 235,426 438,133

22-45 Yrs 30,579 26,504 81,565 123,934 262,582

46-64 Yrs 14,008 9,810 44,150 63,740 131,708

Over 64 Yrs 629 431 1,538 2,480 5,078

TOTAL 90,314 73,662 247,945 425,580 837,501

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs 65,912 34,486 130,075 9,536 240,009

22-45 Yrs 37,971 21,243 88,858 9,071 157,143

46-64 Yrs 19,067 9,794 48,081 3,812 80,754

Over 64 Yrs 250 132 712 60 1,154

TOTAL 123,200 65,655 267,726 22,479 479,060

LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs 94,227 41,002 23,853 21,393 98,105 278,580

22-45 Yrs 45,807 20,627 16,800 15,212 50,889 149,335

46-64 Yrs 19,443 8,607 6,425 6,400 23,006 63,881

Over 64 Yrs 647 267 192 169 779 2,054

TOTAL 160,124 70,503 47,270 43,174 172,779 493,850


33

Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 54,937 13,104 7,983 9,771 85,795

22-45 Yrs 33,466 8,473 6,344 6,424 54,707

46-64 Yrs 16,072 3,649 2,923 2,705 25,349

Over 64 Yrs 186 31 27 36 280

TOTAL 104,661 25,257 17,277 18,936 166,131

NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs 45,134 98,063 23,845 167,042

22-45 Yrs 28,548 59,084 15,764 103,396

46-64 Yrs 13,073 29,230 6,521 48,824

Over 64 Yrs 261 473 132 866

TOTAL 87,016 186,850 46,262 320,128


34

HealthChoices Enrollment 3rd Quarter 2016 AID CATEGORY DISTRIBUTION

Southeast B&CC <1%

Newly Eligible (19-20)

3%

TANF/HB/MAGI (Ages 21+)

11%

Newly Eligible (21+) 26%

SSI & HH 17%

TANF/HB/MAGI (Ages 0-20)

43%

Southwest B&CC <1%


3%


11%


SSI & HH 19%


40% Lehigh/Capital B&CC

<1%


11%


SSI & HH 15%


46%


2%

Northwest B&CC <1%


3%


10%


SSI & HH 19%


42%

Northeast B&CC <1%

Newly Eligible(19-20)

3%


11%


SSI & HH 16%


44%

Source: Division of Financial Analysis

New Categories of Aid: TANF/HB/MAGI is Temporary Assistance for Needy Families, Healthy Beginnings, and Modified Adjusted Gross Income.

35

HealthChoices Enrollment May 201 7 PCP SELECTION

The table displays the total number of new members that voluntarily enrolled in HealthChoices and selected a PCP as a percentage of total new members that voluntarily enrolled in HealthChoices.

May 2017

Zone Percentage

Southeast 93.2%

Southwest 94.1%

Lehigh/Capital 94.2%

Northwest 94.3%

Northeast 93.9%

Total 93.8%

Source: Maximus

36

Medical Assistance Transportation Program

37

Based on Data Submitted by Each County

MATP 1Q FY 15/16

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips

Mileage

Reimbursement

Trips

Total Trips Client Utilization

Bucks $ 545,593 20,246 - 15,093 35,339 1.8%

Chester $ 634,251 15,712 1,728 2,927 20,367 1.8%

Delaware $ 1,225,350 28,753 - 14,616 43,369 1.2%

Montgomery $ 685,641 21,991 - 8,098 30,089 1.3%

Philadelphia $ 9,388,435 274,232 786,738 15,928 1,076,898 3.7%

HC-SE Zone $ 12,479,270 360,934 788,466 56,662 1,206,062 9.8%

38

MATP 1Q FY 15/16

Southwest


Mileage

Reimbursement

Trips


Allegheny $ 2,327,010 48,022 143,153 32,916 224,091 4.3%

Armstrong $ 455,107 10,858 - 5,642 16,500 5.9%

Beaver $ 469,551 12,285 277 23,273 35,835 3.0%

Bedford $ 144,878 5,447 - 3,439 8,886 5.1%

Blair $ 291,416 14,053 1,941 3,358 19,352 2.8%

Butler $ 601,101 15,405 - 3,111 18,516 4.4%

Cambria $ 938,134 29,626 4,382 3,434 37,442 5.9%

Fayette $ 332,091 17,914 414 16,432 34,760 3.4%

Greene $ 146,280 5,015 - 2,566 7,581 4.2%

Indiana $ 296,504 8,613 492 6,220 15,325 4.4%

Lawrence $ 233,470 8,187 2,269 17,081 27,537 4.0%

Somerset $ 228,186 5,521 - 6,982 12,503 4.0%

Washington $ 521,912 19,286 856 14,179 34,321 4.5%

Westmoreland $ 563,123 18,882 99 18,330 37,311 2.6%

HC-SW Zone $ 7,548,763 219,114 153,883 156,963 529,960 58.3%

39

MATP 1Q FY 15/16

Lehigh/Capital


Mileage

Reimbursement

Trips


Berks $ 528,002 22,366 13,066 3,632 39,064 2.6%

Cumberland $ 84,282 4,882 - 1,442 6,324 1.3%

Dauphin $ 754,055 29,515 6,669 1,971 38,155 2.6%

Franklin $ 128,901 3,904 - 2,798 6,702 1.7%

Fulton $ 104,685 2,352 - 1,276 3,628 8.1%

Huntingdon $ 150,245 3,601 - 5,488 9,089 5.9%

Lancaster $ 711,761 24,579 1,254 4,190 30,023 1.5%

Lebanon $ 326,461 17,373 138 1,394 18,905 2.0%

Lehigh $ 813,803 28,357 - 8,414 36,771 0.0%

Northampton $ 510,838 18,790 - 5,520 24,310 0.0%

Perry $ 94,201 2,226 - 1,215 3,441 4.1%

York/Adams $ 309,561 8,975 1,100 3,524 13,599 0.8%

HC-L/C Zone $ 4,516,795 166,920 22,227 40,864 230,011 30.7%

40

MATP 1Q FY 15/16

Northwest

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Cameron $ 48,719 541 6 263 810 2.9%

Clarion $ 152,632 3,079 - 1,906 4,985 9.4%

Clearfield $ 262,209 8,115 - 7,162 15,277 4.1%

Crawford $ 277,579 3,458 750 13,821 18,029 5.1%

Elk $ 141,774 2,600 1 1,193 3,794 3.0%

Erie $ 703,388 26,627 - 5,220 31,847 1.3%

Forest $ 23,731 534 - 196 730 3.5%

Jefferson $ 240,549 4,938 - 3,311 8,249 7.2%

McKean $ 230,539 2,671 29 934 3,634 2.1%

Mercer $ 194,625 8,851 - 3,337 12,188 2.8%

Potter $ 146,543 1,846 - 1,256 3,102 6.8%

Venango $ 267,250 5,719 331 2,087 8,137 3.5%

Warren $ 120,714 3,365 117 2,754 6,236 4.4%

HC-Northwest Zone $ 2,810,252 72,344 1,234 43,440 117,018 56.1%

41

MATP 1Q FY 15/16

Northeast

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Bradford/Tioga $ 275,791 6,516 179 1,818 8,513 0.0%

Carbon $ 249,065 6,707 - 1,368 8,075 2.8%

Centre $ 108,288 4,628 - 1,928 6,556 3.0%

Clinton $ 187,754 3,633 - 466 4,099 3.3%

Columbia $ 153,511 4,660 - 2,539 7,199 2.8%

Juniata $ 22,142 666 - 295 961 1.7%

Lackawanna $ 238,053 7,399 2,990 6,376 16,765 1.4%

Luzerne $ 388,064 20,240 1,090 7,789 29,119 2.5%

Lycoming $ 475,012 11,793 1,784 3,615 17,192 3.6%

Mifflin $ 118,238 5,131 - 847 5,978 3.7%

Monroe $ 191,419 5,528 825 4,444 10,797 1.3%

Montour $ 47,689 1,652 - 880 2,532 5.2%

Northumberland $ 130,239 7,293 - 2,970 10,263 2.7%

Pike $ 61,135 1,353 - 2,346 3,699 1.4%

Schuylkill $ 245,397 5,400 1,214 2,374 8,988 1.8%

Snyder $ 79,333 2,705 - 788 3,493 4.4%

Sullivan $ 19,082 343 37 96 476 3.5%

Susquehanna $ 128,918 2,547 - 1,612 4,159 4.0%

Union $ 46,373 1,639 - 564 2,203 5.5%

Wayne $ 116,258 4,209 - 1,371 5,580 2.9%

Wyoming $ 51,870 1,257 - 890 2,147 1.9%

HC-Northeast Zone $ 3,333,631 105,299 8,119 45,376 158,794 59.5%

42

Useful Information

To view a complete Pennsylvania Medicaid Managed Care Organization (MCO) Directory go to http://www.dhs.pa.gov/provider/healthcaremedicalassistance/manag edcareinformation/ and choose the MCO Directory.

43

http://www.dhs.pa.gov/provider/healthcaremedicalassistance/managedcareinformation/

BMCO monthly physical health managed care program ......95,581 11,973 21,750 8,391 23,644 20,043...

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