BMCO Monthly Physical Health Managed Care Program ... Ca… · Monthly Physical Health Managed Care...

BMCO Monthly Physical Health Managed Care Program Enrollment Report

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.

Released: September 17, 2020

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

Table of Contents

2

3

HealthChoices

Managed Care

Erie

Crawford

Mercer

Warren McKean Potter Tioga Bradford Susquehanna Wayne

Pike

Lackawanna

Monroe Luzerne

Wyoming

Carbon

Schuylkill

Columbia

Sullivan Lycoming

Montour Northumberland 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 ENROLLMENT BY PLAN AND BY COUNTY August 2020

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL 09 Bucks 6,183 8,277 13,684 43,844 71,988 15 Chester 14,219 8,162 3,476 24,563 50,420 23 Delaware 9,608 10,964 9,783 74,487 104,842 46 Montgomery 9,876 11,710 11,713 60,060 93,359 51 Philadelphia 56,762 40,345 206,357 253,821 557,285 TOTAL 96,648 79,458 245,013 456,775 877,894 PERCENTAGE 11% 9% 28% 52%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL 02 Allegheny 57,778 22,900 108,682 9,927 199,287 03 Armstrong 1,057 679 10,206 498 12,440 04 Beaver 10,482 2,664 14,264 1,466 28,876 05 Bedford 690 1,095 6,273 687 8,745 07 Blair 5,520 3,371 15,314 2,103 26,308 10 Butler 4,685 1,345 14,996 1,042 22,068 11 Cambria 3,592 5,056 16,175 2,720 27,543 26 Fayette 3,669 8,663 20,557 862 33,751 30 Greene 784 2,956 3,623 379 7,742 32 Indiana 2,275 1,812 9,420 739 14,246 37 Lawrence 6,534 1,686 9,426 824 18,470 56 Somerset 1,626 2,704 7,065 1,011 12,406 63 Washington 5,465 5,494 20,687 1,807 33,453 65 Westmoreland 10,606 7,888 33,956 2,480 54,930 TOTAL 114,763 68,313 290,644 26,545 500,265 PERCENTAGE 23% 14% 58% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 9/09/20 5

Source: PA Department of Human Services Enterprise Data Warehouse Updated 9/09/20


cont. LEHIGH/CAPITAL

County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL 01 Adams 3,843 4,686 1,454 1,444 1,501 12,928 06 Berks 14,339 9,262 8,073 10,281 42,698 84,653 21 Cumberland 11,910 4,451 4,810 3,841 5,525 30,537 22 Dauphin 27,263 11,314 9,198 8,567 7,217 63,559 28 Franklin 1,287 2,021 8,461 651 12,123 24,543 29 Fulton 183 387 796 552 700 2,618 31 Huntingdon 428 661 1,122 3,463 1,706 7,380 36 Lancaster 22,698 11,499 3,996 12,215 30,669 81,077 38 Lebanon 14,318 2,162 2,166 2,583 3,666 24,895 39 Lehigh 22,249 6,160 3,942 5,821 41,476 79,648 48 Northampton 12,178 3,071 2,871 3,058 26,154 47,332 50 Perry 3,360 697 857 643 1,130 6,687 67 York 20,904 22,143 9,380 9,755 15,652 77,834 TOTAL 154,960 78,514 57,126 62,874 190,217 543,691 PERCENTAGE 29% 14% 11% 12% 35%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL 12 Cameron 832 34 113 55 1,034 16 Clarion 4,600 653 582 611 6,446 17 Clearfield 10,338 1,262 2,208 1,934 15,742 20 Crawford 12,573 1,013 1,156 1,163 15,905 24 Elk 3,849 458 335 365 5,007 25 Erie 33,766 12,888 6,040 10,319 63,013 27 Forest 591 81 65 53 790 33 Jefferson 6,843 807 372 461 8,483 42 McKean 6,303 242 1,269 707 8,521 43 Mercer 14,571 3,546 2,248 2,097 22,462 53 Potter 1,838 46 1,235 81 3,200 61 Venango 7,168 773 1,001 963 9,905 62 Warren 4,804 707 803 505 6,819

TOTAL 108,076 22,510 17,427 19,314 167,327 PERCENTAGE 65% 13% –10% 12%

6


cont.

NORTHEAST County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 3,475 4,762 3,342 11,579 13 Carbon 8,408 2,499 1,138 12,045 14 Centre 2,607 6,496 2,677 11,780 18 Clinton 1,221 5,039 795 7,055 19 Columbia 1,594 7,345 1,282 10,221 34 Juniata 833 1,785 663 3,281 35 Lackawanna 8,555 32,694 6,365 47,614 40 Luzerne 20,128 48,745 9,243 78,116 41 Lycoming 5,184 15,426 1,883 22,493 44 Mifflin 2,145 4,643 1,648 8,436 45 Monroe 16,385 12,406 5,469 34,260 47 Montour 393 1,621 307 2,321 49 Northumberland 3,686 11,599 3,610 18,895 52 Pike 3,050 5,477 1,482 10,009 54 Schuylkill 10,222 14,254 3,090 27,566 55 Snyder 1,226 3,386 836 5,448 57 Sullivan 155 517 158 830 58 Susquehanna 1,313 4,702 1,020 7,035 59 Tioga 6,179 978 636 7,793 60 Union 855 2,883 696 4,434 64 Wayne 1,762 5,763 1,293 8,818 66 Wyoming 788 3,678 603 5,069

TOTAL 100,164 196,698 48,236 345,098 PERCENTAGE 29% 57% 14%


Mandatory MARKET SHARE BY PLAN – STATEWIDE August 2020

Total Enrollment = 2,434,275

AmeriHealth NE

Aetna 230,679

9%

AmeriHealth 207,644

9%

Gateway 292,233

12%

Health Partners 245,013

10%

Keystone 456,775

19%

United 243,475

10%

UPMC 461,594

19%

100,164 4%

Geisinger 196,698

8%


-

-

Mandatory MARKET SHARE BY ZONE AND BY PLAN August 2020

Aetna Southeast Southwest 26,545 5%

Lehigh/Capital

UPMC 62,874

12%

Northwest

Aetna 57,126

11%

Ameri Health

190,217 35%

Gateway 154,960

28%

United 78,514

14%

Northeast Ameri-

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 9/09/20

Aetna 79,458

9%

Health Partners 245,013

28%

Keystone 456,775

52%

United 96,648

11% Gateway 114,763

23%

United 68,313

14%

UPMC 290,644

58%

Aetna 19,314

12%

Health 17,427

10%

Gateway 22,510

13%

UPMC 108,076

65%

Aetna 48,236

14%

Ameri Health NE 100,164

29%

Geisinger 196,698

57%

9

Mandatory ENROLLMENT BY PLAN, BY RACE AND BY COUNTY August 2020

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

Black or African American

42 United 705 2,547 4,941 2,347 34,567 45,107 43 Aetna 796 1,312 4,972 2,463 24,176 33,719 45 Health Partners 1,523 571 5,109 3,231 96,786 107,220 47 Keystone 4,565 4,095 35,626 13,915 151,261 209,462 Southeast MCOs 7,589 8,525 50,648 21,956 306,790 395,508

American Indian or Alaskan Native

42 United 13 43 20 40 105 221 43 Aetna 36 58 21 61 106 282 45 Health Partners 42 12 26 42 268 390 47 Keystone 99 99 119 209 499 1,025 Southeast MCOs 190 212 186 352 978 1,918

Asian

42 United 305 342 513 526 3,472 5,158 43 Aetna 370 234 557 812 1,806 3,779 45 Health Partners 881 91 465 894 8,238 10,569 47 Keystone 1,644 819 5,034 4,177 20,466 32,140 Southeast MCOs 3,200 1,486 6,569 6,409 33,982 51,646

White

42 United 4,005 7,808 2,974 4,930 8,773 28,490 43 Aetna 5,659 4,973 4,180 6,302 7,294 28,408 45 Health Partners 8,501 2,056 2,801 5,345 33,587 52,290 47 Keystone 30,515 14,793 25,922 30,469 41,565 143,264 Southeast MCOs 48,680 29,630 35,877 47,046 91,219 252,452

Other or system default

42 United 758 2,398 717 1,396 7,518 12,787 43 Aetna 886 986 735 1,320 5,241 9,168 45 Health Partners 1,978 464 944 1,558 60,626 65,570 47 Keystone 5,021 3,289 5,180 8,240 31,828 53,558 Southeast MCOs 8,643 7,137 7,576 12,514 105,213 141,083

Native Hawaiian or Other Pacific Islander

42 United 22 31 26 38 173 290 43 Aetna 33 14 24 36 119 226 45 Health Partners 32 17 21 36 444 550 47 Keystone 74 45 96 117 325 657 Southeast MCOs 161 107 167 227 1,061 1,723

Unknown

42 United 375 1,050 417 599 2,154 4,595 43 Aetna 497 585 475 716 1,603 3,876 45 Health Partners 727 265 417 607 6,408 8,424 47 Keystone 1,926 1,423 2,510 2,933 7,877 16,669 Southeast MCOs 3,525 3,323 3,819 4,855 18,042 33,564

MCO TOTAL

42 United 6,183 14,219 9,608 9,876 56,762 96,648 43 Aetna 8,277 8,162 10,964 11,710 40,345 79,458 45 Health Partners 13,684 3,476 9,783 11,713 206,357 245,013 47 Keystone 43,844 24,563 74,487 60,060 253,821 456,775

TOTAL 71,988 50,420 104,842 93,359 557,285 877,894 Racial/Ethnic information is self-reported by consumers.


10


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


31 Gateway 28,001 26 2,587 12 405 203 585 336 32 United 9,226 21 554 18 266 58 1,083 849 34 UPMC 35,081 148 2,319 72 827 417 1,562 1,671 59 Aetna 3,646 9 315 16 118 34 731 98 Southwest MCOs 75,954 204 5,775 118 1,616 712 3,961 2,954


31 Gateway 157 0 20 1 7 6 15 4 32 United 78 3 1 0 10 5 4 10 34 UPMC 387 19 45 9 26 24 34 50 59 Aetna 34 0 8 0 4 8 1 5 Southwest MCOs 656 22 74 10 47 43 54 69

Asian

31 Gateway 787 3 21 0 9 19 10 15 32 United 561 2 28 9 32 19 16 12 34 UPMC 5,482 34 122 22 85 166 35 52 59 Aetna 265 1 9 2 9 17 8 2 Southwest MCOs 7,095 40 180 33 135 221 69 81

White

31 Gateway 24,898 1,004 7,550 659 5,003 4,306 2,864 3,207 32 United 10,812 626 1,889 1,047 2,980 1,153 3,756 7,549 34 UPMC 56,681 9,840 11,034 6,024 13,993 13,556 13,964 18,151 59 Aetna 4,619 475 1,027 646 1,905 900 1,865 700 Southwest MCOs 97,010 11,945 21,500 8,376 23,881 19,915 22,449 29,607


31 Gateway 1,979 7 219 11 59 75 66 50 32 United 1,089 16 112 13 41 69 123 97 34 UPMC 5,856 75 430 110 195 407 328 251 59 Aetna 677 5 66 15 36 42 63 32 Southwest MCOs 9,601 103 827 149 331 593 580 430



Unknown

31 Gateway 1,923 17 84 7 36 73 51 51 32 United 1,100 11 76 8 42 39 67 134 34 UPMC 4,998 85 303 36 182 408 236 361 59 Aetna 650 8 36 7 30 41 45 20 Southwest MCOs 8,671 121 499 58 290 561 399 566

MCO TOTAL

31 Gateway 57,778 1,057 10,482 690 5,520 4,685 3,592 3,669 32 United 22,900 679 2,664 1,095 3,371 1,345 5,056 8,663 34 UPMC 108,682 10,206 14,264 6,273 15,314 14,996 16,175 20,557 59 Aetna 9,927 498 1,466 687 2,103 1,042 2,720 862

TOTAL 199,287 12,440 28,876 8,745 26,308 22,068 27,543 33,751 Racial/Ethnic information is self-reported by consumers.


11


Southwest cont.

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


31 Gateway 16 84 981 19 699 1,531 35,485 32 United 35 99 239 27 663 780 13,918 34 UPMC 43 296 973 82 1,873 2,449 47,813 59 Aetna 5 50 148 27 201 248 5,646 Southwest MCOs 99 529 2,341 155 3,436 5,008 102,862


31 Gateway 0 6 8 2 11 37 274 32 United 3 3 3 5 16 23 164 34 UPMC 14 31 22 11 33 75 780 59 Aetna 1 1 2 3 9 8 84 Southwest MCOs 18 41 35 21 69 143 1,302

Asian

31 Gateway 3 13 6 2 13 45 946 32 United 2 7 4 7 23 31 753 34 UPMC 20 65 45 20 158 280 6,586 59 Aetna 1 4 5 3 10 20 356 Southwest MCOs 26 89 60 32 204 376 8,641

White

31 Gateway 747 2,102 5,398 1,561 4,502 8,511 72,312 32 United 2,886 1,646 1,381 2,596 4,530 6,589 49,440 34 UPMC 3,481 8,707 8,057 6,776 17,541 29,148 216,953 59 Aetna 357 634 632 950 1,473 1,979 18,162 Southwest MCOs 7,471 13,089 15,468 11,883 28,046 46,227 356,867


31 Gateway 10 36 76 20 120 212 2,940 32 United 19 31 41 42 130 210 2,033 34 UPMC 39 131 210 78 490 847 9,447 59 Aetna 6 31 24 9 58 105 1,169 Southwest MCOs 74 229 351 149 798 1,374 15,589


31 Gateway 0 1 3 1 2 7 59 32 United 0 1 0 0 6 5 71 34 UPMC 1 3 8 0 17 22 325 59 Aetna 0 1 2 0 1 1 60 Southwest MCOs 1 6 13 1 26 35 515

Unknown

31 Gateway 8 33 62 21 118 263 2,747 32 United 11 25 18 27 126 250 1,934 34 UPMC 25 187 111 98 575 1,135 8,740 59 Aetna 9 18 11 19 55 119 1,068 Southwest MCOs 53 263 202 165 874 1,767 14,489

MCO TOTAL

31 Gateway 784 2,275 6,534 1,626 5,465 10,606 114,763 32 United 2,956 1,812 1,686 2,704 5,494 7,888 68,313 34 UPMC 3,623 9,420 9,426 7,065 20,687 33,956 290,644 59 Aetna 379 739 824 1,011 1,807 2,480 26,545

TOTAL 7,742 14,246 18,470 12,406 33,453 54,930 500,265

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 9/09/20

12


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


51 Gateway 129 1,230 1,589 10,583 124 4 18 52 United 229 851 705 3,950 216 6 25 53 Aetna 71 968 547 2,879 649 18 56 54 UPMC 62 789 405 2,379 51 16 88 57 AmeriHealth 56 3,399 647 2,053 987 25 30 Lehigh/Capital MCOs 547 7,237 3,893 21,844 2,027 69 217


51 Gateway 18 29 35 67 12 1 0 52 United 14 24 22 41 7 0 0 53 Aetna 6 23 24 54 15 1 0 54 UPMC 6 18 15 31 3 0 1 57 AmeriHealth 2 73 26 38 48 2 1 Lehigh/Capital MCOs 46 167 122 231 85 4 2

Asian

51 Gateway 36 163 345 1,440 9 0 2 52 United 41 118 232 1,010 13 0 2 53 Aetna 14 132 182 709 70 3 3 54 UPMC 21 155 209 1,035 3 1 19 57 AmeriHealth 11 277 154 423 89 0 4 Lehigh/Capital MCOs 123 845 1,122 4,617 184 4 30

White

51 Gateway 3,279 6,681 7,940 8,190 960 173 393 52 United 3,643 4,804 2,600 3,730 1,417 365 610 53 Aetna 1,133 4,430 3,249 3,650 6,544 750 1,039 54 UPMC 1,148 6,110 2,435 3,243 508 533 3,281 57 AmeriHealth 1,237 14,562 3,752 2,682 8,667 640 1,629 Lehigh/Capital MCOs 10,440 36,587 19,976 21,495 18,096 2,461 6,952


51 Gateway 193 5,498 1,352 5,466 105 1 13 52 United 553 2,831 584 1,791 228 11 17 53 Aetna 139 1,979 464 1,253 662 17 14 54 UPMC 115 2,456 523 1,176 45 2 51 57 AmeriHealth 119 22,000 613 1,387 1,405 21 20 Lehigh/Capital MCOs 1,119 34,764 3,536 11,073 2,445 52 115



Unknown

51 Gateway 182 708 623 1,475 76 4 2 52 United 202 591 290 750 136 5 7 53 Aetna 88 500 329 618 510 7 10 54 UPMC 92 712 236 661 41 0 23 57 AmeriHealth 74 2,246 317 614 901 12 20 Lehigh/Capital MCOs 638 4,757 1,795 4,118 1,664 28 62

MCO TOTAL

51 Gateway 3,843 14,339 11,910 27,263 1,287 183 428 52 United 4,686 9,262 4,451 11,314 2,021 387 661 53 Aetna 1,454 8,073 4,810 9,198 8,461 796 1,122 54 UPMC 1,444 10,281 3,841 8,567 651 552 3,463 57 AmeriHealth 1,501 42,698 5,525 7,217 12,123 700 1,706

TOTAL 12,928 84,653 30,537 63,559 24,543 2,618 7,380

Source: PA Department of Racial/Ethnic Human Services Enterprise information is self- Data Warehouse – Updated

reported by consumers. 9/09/20 13


Lehigh/Capital cont.

Racial/Ethnic information is self-reported by consumers.

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


51 Gateway 1,926 601 3,119 1,640 71 2,423 23,457 52 United 1,424 122 940 425 13 3,924 12,830 53 Aetna 419 106 596 423 36 1,494 8,262 54 UPMC 1,117 145 767 334 23 1,294 7,470 57 AmeriHealth 3,362 150 4,862 2,904 23 2,374 20,872 Lehigh/Capital MCOs 8,248 1,124 10,284 5,726 166 11,509 72,891


51 Gateway 65 16 31 33 2 101 410 52 United 27 0 8 9 0 76 228 53 Aetna 12 5 12 21 5 48 226 54 UPMC 40 12 10 10 1 69 216 57 AmeriHealth 63 5 65 93 1 82 499 Lehigh/Capital MCOs 207 38 126 166 9 376 1,579

Asian

51 Gateway 828 155 338 217 6 228 3,767 52 United 325 50 168 76 2 273 2,310 53 Aetna 95 35 85 75 7 164 1,574 54 UPMC 449 49 178 70 3 134 2,326 57 AmeriHealth 759 47 692 552 4 186 3,198 Lehigh/Capital MCOs 2,456 336 1,461 990 22 985 13,175

White

51 Gateway 13,890 9,295 14,716 7,139 3,157 14,676 90,489 52 United 6,144 1,394 3,746 1,910 624 12,304 43,291 53 Aetna 2,518 1,494 2,421 1,753 767 5,914 35,662 54 UPMC 7,334 1,753 3,712 1,958 562 6,235 38,812 57 AmeriHealth 15,192 1,960 28,085 16,516 1,055 8,828 104,805 Lehigh/Capital MCOs 45,078 15,896 52,680 29,276 6,165 47,957 313,059


51 Gateway 4,120 3,726 2,998 2,563 77 2,622 28,734 52 United 2,611 474 796 453 32 4,531 14,912 53 Aetna 643 432 537 399 26 1,230 7,795 54 UPMC 1,997 488 744 465 37 1,400 9,499 57 AmeriHealth 8,599 1,298 5,588 4,779 24 3,167 49,020 Lehigh/Capital MCOs 17,970 6,418 10,663 8,659 196 12,950 109,960


51 Gateway 44 19 71 30 1 35 305 52 United 35 2 58 9 0 36 251 53 Aetna 16 2 25 12 0 29 189 54 UPMC 25 8 34 23 0 33 224 57 AmeriHealth 85 22 162 112 0 70 658 Lehigh/Capital MCOs 205 53 350 186 1 203 1,627

Unknown

51 Gateway 1,825 506 976 556 46 819 7,798 52 United 933 120 444 189 26 999 4,692 53 Aetna 293 92 266 188 16 501 3,418 54 UPMC 1,253 128 376 198 17 590 4,327 57 AmeriHealth 2,609 184 2,022 1,198 23 945 11,165 Lehigh/Capital MCOs 6,913 1,030 4,084 2,329 128 3,854 31,400

MCO TOTAL

51 Gateway 22,698 14,318 22,249 12,178 3,360 20,904 154,960 52 United 11,499 2,162 6,160 3,071 697 22,143 78,514 53 Aetna 3,996 2,166 3,942 2,871 857 9,380 57,126 54 UPMC 12,215 2,583 5,821 3,058 643 9,755 62,874 57 AmeriHealth 30,669 3,666 41,476 26,154 1,130 15,652 190,217

TOTAL 81,077 24,895 79,648 47,332 6,687 77,834 543,691



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


35 UPMC 14 138 135 423 49 5,212 8 36 Gateway 0 11 25 46 7 3,324 2 37 AmeriHealth 4 30 39 43 3 1,261 1 56 Aetna 1 23 30 37 7 2,739 1 Northwest MCOs 19 202 229 549 66 12,536 12


35 UPMC 1 4 23 35 9 132 3 36 Gateway 0 3 0 2 0 38 4 37 AmeriHealth 0 3 1 2 2 15 0 56 Aetna 0 2 1 0 1 42 0 Northwest MCOs 1 12 25 39 12 227 7

Asian

35 UPMC 7 15 35 41 13 1,289 1 36 Gateway 0 2 2 0 1 198 0 37 AmeriHealth 3 0 8 2 0 168 0 56 Aetna 0 3 5 4 3 139 0 Northwest MCOs 10 20 50 47 17 1,794 1

White

35 UPMC 802 4,329 9,968 11,732 3,734 24,522 573 36 Gateway 33 625 1,209 941 445 8,303 74 37 AmeriHealth 106 538 2,111 1,080 318 4,138 64 56 Aetna 53 563 1,853 1,086 350 6,588 50 Northwest MCOs 994 6,055 15,141 14,839 4,847 43,551 761


35 UPMC 7 49 84 140 27 1,927 4 36 Gateway 1 8 14 10 4 828 1 37 AmeriHealth 0 3 26 14 8 340 0 56 Aetna 1 9 28 13 0 613 1 Northwest MCOs 9 69 152 177 39 3,708 6



Unknown

35 UPMC 1 62 87 199 14 645 2 36 Gateway 0 4 11 14 1 188 0 37 AmeriHealth 0 8 23 15 4 107 0 56 Aetna 0 11 17 23 3 186 1 Northwest MCOs 1 85 138 251 22 1,126 3

MCO TOTAL

35 UPMC 832 4,600 10,338 12,573 3,849 33,766 591 36 Gateway 34 653 1,262 1,013 458 12,888 81 37 AmeriHealth 113 582 2,208 1,156 335 6,040 65 56 Aetna 55 611 1,934 1,163 365 10,319 53

TOTAL 1,034 6,446 15,742 15,905 5,007 63,013 790


15


Northwest cont. 33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren Northwest


35 UPMC 59 81 1,838 20 218 52 8,247 36 Gateway 5 4 637 1 37 12 4,111 37 AmeriHealth 6 13 451 15 23 8 1,897 56 Aetna 8 12 416 1 47 6 3,328 Northwest MCOs 78 110 3,342 37 325 78 17,583



Asian

35 UPMC 14 22 90 0 38 17 1,582 36 Gateway 4 1 23 0 2 1 234 37 AmeriHealth 1 11 17 2 4 2 218 56 Aetna 1 0 17 1 1 3 177 Northwest MCOs 20 34 147 3 45 23 2,211

White

35 UPMC 6,687 6,115 12,050 1,782 6,715 4,641 93,650 36 Gateway 788 233 2,766 43 706 679 16,845 37 AmeriHealth 354 1,227 1,660 1,184 945 776 14,501 56 Aetna 446 685 1,556 75 876 483 14,664 Northwest MCOs 8,275 8,260 18,032 3,084 9,242 6,579 139,660





Unknown


MCO TOTAL

35 UPMC 7,897 7,936 21,027 3,059 9,262 6,297 156,461 36 Gateway 807 242 3,546 46 773 707 22,510 37 AmeriHealth 372 1,269 2,248 1,235 1,001 803 17,427 56 Aetna 461 707 2,097 81 963 505 19,314

TOTAL 8,483 8,521 22,462 3,200 9,905 6,819 167,327


16


Northeast

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


41 AmeriHealth NE 43 355 141 46 51 12 1,027 2,335 44 Geisinger 64 109 282 118 258 18 2,960 5,028 50 Aetna 46 68 171 39 95 11 849 1,576 Northeast MCOs 153 532 594 203 404 41 4,836 8,939


41 AmeriHealth NE 13 23 4 3 7 1 27 48 44 Geisinger 9 15 23 12 15 2 79 74 50 Aetna 9 6 4 0 3 4 30 11 Northeast MCOs 31 44 31 15 25 7 136 133

Asian

41 AmeriHealth NE 24 28 79 10 12 0 258 115 44 Geisinger 13 10 138 14 50 9 905 422 50 Aetna 8 9 82 0 18 4 187 99 Northeast MCOs 45 47 299 24 80 13 1,350 636

White

41 AmeriHealth NE 3,260 7,398 2,179 1,117 1,427 690 5,574 10,604 44 Geisinger 4,515 2,118 5,749 4,756 6,685 1,569 22,985 32,006 50 Aetna 3,164 933 2,214 722 1,071 595 4,081 5,780 Northeast MCOs 10,939 10,449 10,142 6,595 9,183 2,854 32,640 48,390


41 AmeriHealth NE 60 371 120 21 56 97 1,075 6,293 44 Geisinger 71 166 168 71 223 143 3,759 9,610 50 Aetna 49 79 132 19 62 45 767 1,440 Northeast MCOs 180 616 420 111 341 285 5,601 17,343



Unknown

41 AmeriHealth NE 73 226 75 16 40 33 580 670 44 Geisinger 86 78 123 66 107 41 1,958 1,471 50 Aetna 62 39 67 15 27 4 432 309 Northeast MCOs 221 343 265 97 174 78 2,970 2,450

MCO TOTAL 41 AmeriHealth NE 3,475 8,408 2,607 1,221 1,594 833 8,555 20,128 44 Geisinger 4,762 2,499 6,496 5,039 7,345 1,785 32,694 48,745 50 Aetna 3,342 1,138 2,677 795 1,282 663 6,365 9,243

TOTAL 11,579 12,045 11,780 7,055 10,221 3,281 47,614 78,116




Northeast cont.

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


41 AmeriHealth NE 893 69 2,908 22 281 374 488 26 44 Geisinger 2,265 120 2,302 35 521 334 549 99 50 Aetna 350 51 1,251 4 279 154 200 25 Northeast MCOs 3,508 240 6,461 61 1,081 862 1,237 150



Asian


White

41 AmeriHealth NE 4,101 2,012 9,593 346 3,082 2,063 8,547 1,127 44 Geisinger 12,636 4,373 7,060 1,476 10,263 4,393 12,523 3,116 50 Aetna 1,402 1,519 2,700 273 3,075 1,050 2,606 768 Northeast MCOs 18,139 7,904 19,353 2,095 16,420 7,506 23,676 5,011


41 AmeriHealth NE 107 42 2,619 17 220 384 843 39 44 Geisinger 260 73 2,026 65 493 447 799 106 50 Aetna 68 46 1,010 19 159 169 172 21 Northeast MCOs 435 161 5,655 101 872 1,000 1,814 166



Unknown

41 AmeriHealth NE 58 13 921 4 72 161 247 8 44 Geisinger 157 42 697 22 224 196 273 45 50 Aetna 35 20 361 3 76 86 76 12 Northeast MCOs 250 75 1,979 29 372 443 596 65

MCO TOTAL 41 AmeriHealth NE 5,184 2,145 16,385 393 3,686 3,050 10,222 1,226 44 Geisinger 15,426 4,643 12,406 1,621 11,599 5,477 14,254 3,386 50 Aetna 1,883 1,648 5,469 307 3,610 1,482 3,090 836

TOTAL 22,493 8,436 34,260 2,321 18,895 10,009 27,566 5,448


18


Northeast cont.

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


41 AmeriHealth NE 0 17 110 39 63 11 9,311 44 Geisinger 5 46 20 217 138 34 15,522 50 Aetna 7 24 20 59 32 8 5,319 Northeast MCOs 12 87 150 315 233 53 30,152


41 AmeriHealth NE 1 0 21 0 13 6 310 44 Geisinger 0 9 0 4 22 12 452 50 Aetna 1 2 2 4 11 2 150 Northeast MCOs 2 11 23 8 46 20 912

Asian

41 AmeriHealth NE 1 4 19 8 21 2 906 44 Geisinger 0 16 3 22 32 14 2,173 50 Aetna 0 1 1 2 5 0 592 Northeast MCOs 1 21 23 32 58 16 3,671

White

41 AmeriHealth NE 147 1,248 5,917 764 1,560 738 73,494 44 Geisinger 501 4,484 933 2,491 5,345 3,500 153,477 50 Aetna 146 956 587 620 1,159 571 35,992 Northeast MCOs 794 6,688 7,437 3,875 8,064 4,809 262,963





Unknown


MCO TOTAL 41 AmeriHealth NE 155 1,313 6,179 855 1,762 788 100,164 44 Geisinger 517 4,702 978 2,883 5,763 3,678 196,698 50 Aetna 158 1,020 636 696 1,293 603 48,236

TOTAL 830 7,035 7,793 4,434 8,818 5,069 345,098


19

Mandatory ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY August 2020

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 7 2 2 8 31 50 43 Aetna 4 5 3 13 21 46 45 Health Partners 9 1 2 11 30 53 47 Keystone 13 5 17 27 46 108 Southeast MCOs 33 13 24 59 128 257

Non-Hispanic

42 United 5,456 10,595 9,038 8,546 49,326 82,961 43 Aetna 7,537 6,819 10,393 10,602 35,345 70,696 45 Health Partners 11,752 3,037 8,981 10,413 140,712 174,895 47 Keystone 38,826 19,900 69,992 52,582 222,867 404,167 Southeast MCOs 63,571 40,351 98,404 82,143 448,250 732,719

Hispanic

42 United 720 3,622 568 1,322 7,405 13,637 43 Aetna 736 1,338 568 1,095 4,979 8,716 45 Health Partners 1,923 438 800 1,289 65,615 70,065 47 Keystone 5,005 4,658 4,478 7,451 30,908 52,500 Southeast MCOs 8,384 10,056 6,414 11,157 108,907 144,918

TOTAL 71,988 50,420 104,842 93,359 557,285 877,894




Southwest

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

Other/Unknown


Non-Hispanic

31 Gateway 56,761 1,047 10,330 685 5,430 4,594 3,520 3,643 32 United 22,345 669 2,567 1,078 3,318 1,309 4,897 8,604 34 UPMC 105,691 10,109 13,982 6,188 15,095 14,689 15,955 20,323 59 Aetna 9,670 491 1,412 681 2,065 1,015 2,658 838 Southwest MCOs 194,467 12,316 28,291 8,632 25,908 21,607 27,030 33,408

Hispanic

31 Gateway 996 10 151 5 90 87 72 26 32 United 544 9 96 17 53 35 157 59 34 UPMC 2,955 95 278 84 218 304 218 230 59 Aetna 250 7 53 6 38 27 61 24 Southwest MCOs 4,745 121 578 112 399 453 508 339

TOTAL 199,287 12,440 28,876 8,745 26,308 22,068 27,543 33,751


21


Southwest cont.

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

Other/Unknown

31 Gateway 0 1 0 0 0 4 31 32 United 0 0 0 0 4 1 21 34 UPMC 1 0 1 3 2 10 70 59 Aetna 0 0 0 0 1 1 11 Southwest MCOs 1 1 1 3 7 16 133

Non-Hispanic

31 Gateway 776 2,258 6,452 1,611 5,370 10,494 112,971 32 United 2,942 1,777 1,638 2,673 5,405 7,753 66,975 34 UPMC 3,598 9,304 9,158 6,985 20,352 33,488 284,917 59 Aetna 374 717 795 999 1,745 2,436 25,896 Southwest MCOs 7,690 14,056 18,043 12,268 32,872 54,171 490,759

Hispanic

31 Gateway 8 16 82 15 95 108 1,761 32 United 14 35 48 31 85 134 1,317 34 UPMC 24 116 267 77 333 458 5,657 59 Aetna 5 22 29 12 61 43 638 Southwest MCOs 51 189 426 135 574 743 9,373

TOTAL 7,742 14,246 18,470 12,406 33,453 54,930 500,265




Lehigh/Capital

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

Other/Unknown


Non-Hispanic

51 Gateway 3,589 7,686 10,916 21,039 1,165 179 416 52 United 3,812 5,814 3,974 9,260 1,821 384 652 53 Aetna 1,286 5,668 4,510 7,946 7,720 786 1,112 54 UPMC 1,272 7,310 3,559 7,411 599 547 3,433 57 AmeriHealth 1,331 15,882 4,988 5,459 10,136 680 1,688 Lehigh/Capital MCOs 11,290 42,360 27,947 51,115 21,441 2,576 7,301

Hispanic

51 Gateway 253 6,649 986 6,220 121 4 12 52 United 872 3,444 474 2,043 200 3 9 53 Aetna 167 2,399 298 1,251 738 10 10 54 UPMC 172 2,970 280 1,156 49 4 30 57 AmeriHealth 170 26,810 534 1,757 1,979 20 18 Lehigh/Capital MCOs 1,634 42,272 2,572 12,427 3,087 41 79

TOTAL 12,928 84,653 30,537 63,559 24,543 2,618 7,380


23


Lehigh/Capital cont.

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

Other/Unknown


Non-Hispanic

51 Gateway 17,664 8,835 10,253 7,955 3,275 17,964 110,936 52 United 8,241 1,482 3,427 2,418 665 16,566 58,516 53 Aetna 3,294 1,575 2,336 2,314 815 7,921 47,283 54 UPMC 9,888 1,867 3,884 2,404 625 8,186 50,985 57 AmeriHealth 19,592 1,849 19,948 18,295 1,107 11,518 112,473 Lehigh/Capital MCOs 58,679 15,608 39,848 33,386 6,487 62,155 380,193

Hispanic

51 Gateway 5,030 5,482 11,990 4,220 83 2,939 43,989 52 United 3,254 680 2,732 650 32 5,571 19,964 53 Aetna 700 590 1,603 553 41 1,458 9,818 54 UPMC 2,316 715 1,932 651 18 1,566 11,859 57 AmeriHealth 11,064 1,817 21,519 7,852 23 4,131 77,694 Lehigh/Capital MCOs 22,364 9,284 39,776 13,926 197 15,665 163,324

TOTAL 81,077 24,895 79,648 47,332 6,687 77,834 543,691




Northwest

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

Other/Unknown


Non-Hispanic

35 UPMC 808 4,554 10,236 12,413 3,803 31,456 589 36 Gateway 34 651 1,253 1,007 457 11,641 77 37 AmeriHealth 111 578 2,182 1,138 329 5,620 65 56 Aetna 54 596 1,904 1,149 361 9,425 52 Northwest MCOs 1,007 6,379 15,575 15,707 4,950 58,142 783

Hispanic

35 UPMC 24 45 102 160 46 2,307 2 36 Gateway 0 2 9 6 1 1,246 4 37 AmeriHealth 2 3 25 17 6 417 0 56 Aetna 1 15 30 11 4 893 1 Northwest MCOs 27 65 166 194 57 4,863 7

TOTAL 1,034 6,446 15,742 15,905 5,007 63,013 790


25


Northwest cont.

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

Other/Unknown


Non-Hispanic

35 UPMC 6,759 6,233 14,376 1,817 7,081 4,762 104,887 36 Gateway 804 241 3,506 44 752 700 21,167 37 AmeriHealth 371 1,258 2,212 1,224 984 792 16,864 56 Aetna 458 704 2,066 81 954 501 18,305 Northwest MCOs 8,392 8,436 22,160 3,166 9,771 6,755 161,223

Hispanic

35 UPMC 82 70 193 21 87 41 3,180 36 Gateway 3 1 39 2 20 7 1,340 37 AmeriHealth 1 11 32 11 17 11 553 56 Aetna 3 3 31 0 9 4 1,005 Northwest MCOs 89 85 295 34 133 63 6,078

TOTAL 8,483 8,521 22,462 3,200 9,905 6,819 167,327




Northeast

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

Other/Unknown


Non-Hispanic

41 AmeriHealth NE 3,429 7,601 2,524 1,182 1,519 721 6,883 12,572 44 Geisinger 4,688 2,279 6,341 4,936 7,035 1,621 26,916 36,695 50 Aetna 3,291 1,033 2,601 771 1,208 601 5,252 7,327 Northeast MCOs 11,408 10,913 11,466 6,889 9,762 2,943 39,051 56,594

Hispanic

41 AmeriHealth NE 46 803 82 39 75 110 1,670 7,555 44 Geisinger 72 220 147 103 310 163 5,767 12,040 50 Aetna 49 105 75 24 74 62 1,112 1,916 Northeast MCOs 167 1,128 304 166 459 335 8,549 21,511

TOTAL 11,579 12,045 11,780 7,055 10,221 3,281 47,614 78,116




Northeast cont.

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

Other/Unknown


Non-Hispanic

41 AmeriHealth NE 5,047 2,054 13,166 365 3,302 2,519 8,668 1,173 44 Geisinger 15,127 4,493 9,885 1,545 10,624 4,828 12,868 3,250 50 Aetna 1,827 1,539 4,257 296 3,324 1,232 2,801 816 Northeast MCOs 22,001 8,086 27,308 2,206 17,250 8,579 24,337 5,239

Hispanic

41 AmeriHealth NE 134 91 3,213 28 384 531 1,552 53 44 Geisinger 295 150 2,515 76 975 640 1,385 134 50 Aetna 55 109 1,208 11 285 249 288 20 Northeast MCOs 484 350 6,936 115 1,644 1,420 3,225 207

TOTAL 22,493 8,436 34,260 2,321 18,895 10,009 27,566 5,448




Northeast cont.

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

Other/Unknown


Non-Hispanic

41 AmeriHealth NE 155 1,285 6,115 790 1,657 769 83,496 44 Geisinger 504 4,599 972 2,656 5,527 3,593 170,982 50 Aetna 155 997 625 670 1,224 596 42,443 Northeast MCOs 814 6,881 7,712 4,116 8,408 4,958 296,921

Hispanic


TOTAL 830 7,035 7,793 4,434 8,818 5,069 345,098



Mandatory PLAN MAKE UP BY AGE GROUP AND GENDER August 2020

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs Female 21,946 17,870 58,660 122,237 220,713 Male 22,887 19,393 60,206 132,106 234,592 Total 44,833 37,263 118,866 254,343 455,305

22-45 Yrs Female 19,240 15,508 52,731 86,433 173,912 Male 17,251 15,160 32,395 51,064 115,870 Total 36,491 30,668 85,126 137,497 289,782


Over 64 Yrs Female 408 336 1,044 1,752 3,540 Male 276 233 663 1,109 2,281 Total 684 569 1,707 2,861 5,821

TOTAL 96,648 79,458 245,013 456,775 877,894

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL




Over 64 Yrs Female 122 68 373 39 602 Male 99 47 263 26 435 Total 221 115 636 65 1,037

TOTAL 114,763 68,313 290,644 26,545 500,265



LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs Female 43,700 21,022 13,818 15,528 52,009 146,077 Male 46,474 22,439 14,883 16,627 54,611 155,034 Total 90,174 43,461 28,701 32,155 106,620 301,111

22-45 Yrs Female 30,318 15,198 12,144 12,844 38,218 108,722 Male 15,066 9,611 8,515 8,739 19,399 61,330 Total 45,384 24,809 20,659 21,583 57,617 170,052

46-64 Yrs Female 10,870 5,400 3,851 4,734 14,846 39,701 Male 7,871 4,510 3,700 4,127 10,145 30,353 Total 18,741 9,910 7,551 8,861 24,991 70,054

Over 64 Yrs Female 418 210 133 157 663 1,581 Male 243 124 82 118 326 893 Total 661 334 215 275 989 2,474

TOTAL 154,960 78,514 57,126 62,874 190,217 543,691

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL




Over 64 Yrs Female 57 11 13 10 91 Male 53 15 15 15 98 Total 110 26 28 25 189

TOTAL 108,076 22,510 17,427 19,314 167,327



NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs Female 25,031 49,715 11,534 86,280

Male 26,420 52,636 12,344 91,400

Total 51,451 102,351 23,878 177,680

22-45 Yrs Female 20,672 39,731 9,973 70,376

Male 12,607 23,878 7,415 43,900

Total 33,279 63,609 17,388 114,276

46-64 Yrs Female 8,553 17,204 3,660 29,417

Male 6,596 13,009 3,209 22,814

Total 15,149 30,213 6,869 52,231

Over 64 Yrs Female 188 338 58 584

Male 97 187 43 327

Total 285 525 101 911

TOTAL 100,164 196,698 48,236 345,098


Mandatory PLAN MAKE UP BY AGE GROUP August 2020

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL < 21 Yrs 44,833 37,263 118,866 254,343 455,305 22-45 Yrs 36,491 30,668 85,126 137,497 289,782 46-64 Yrs 14,640 10,958 39,314 62,074 126,986 Over 64 Yrs 684 569 1,707 2,861 5,821

TOTAL 96,648 79,458 245,013 456,775 877,894 SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL < 21 Yrs 59,797 33,991 144,252 10,966 249,006 22-45 Yrs 37,400 23,634 96,497 11,264 168,795 46-64 Yrs 17,345 10,573 49,259 4,250 81,427 Over 64 Yrs 221 115 636 65 1,037

TOTAL 114,763 68,313 290,644 26,545 500,265 LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL < 21 Yrs 90,174 43,461 28,701 32,155 106,620 301,111 22-45 Yrs 45,384 24,809 20,659 21,583 57,617 170,052 46-64 Yrs 18,741 9,910 7,551 8,861 24,991 70,054 Over 64 Yrs 661 334 215 275 989 2,474

TOTAL 154,960 78,514 57,126 62,874 190,217 543,691


Mandatory PLAN MAKE UP BY AGE GROUP August 2020

NORTHWEST 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 56,996 11,453 8,069 9,447 85,965 22-45 Yrs 34,583 7,708 6,387 7,063 55,741 46-64 Yrs 16,387 3,323 2,943 2,779 25,432 Over 64 Yrs 110 26 28 25 189

TOTAL 108,076 22,510 17,427 19,314 167,327 NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL < 21 Yrs 51,451 102,351 23,878 177,680 22-45 Yrs 33,279 63,609 17,388 114,276 46-64 Yrs 15,149 30,213 6,869 52,231 Over 64 Yrs 285 525 101 911

TOTAL 100,164 196,698 48,236 345,098


-

-

-

-

-

HealthChoices Enrollment AID CATEGORY DISTRIBUTION 3rd Quarter 2019

TANF/HB/MAGI TANF/HB/MAGI Southeast (Ages 21+) Southwest (Ages 21+)

Lehigh/Capital TANF/HB/MAGI (Ages 21+)

3%

11%

TANF/HB/MAGI (Ages 1 20)

42%Disabled/BC&C 15%

Newly Eligible (45+) 9%

Newly Eligible (19-44)

20%

3%TANF/HB/MAGI Northwest (Ages 21+)

TANF/HB/MAGI Northeast

Under Age 1 3%

Source: Bureau of Fiscal Management 3% 3%

11%


40%

Under Age 1

Disabled/BC&C 14%



23%

11%


37%

Under Age 1

Disabled/BC&C 17%



22%

11%


39%

Under Age 1

Disabled/BC&C 18%



21%

(Ages 21+) 11%


39%

Under Age 1

Disabled/BC&C 15%



22%

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

35

HealthChoices Enrollment PCP SELECTION August 2020

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.

August 2020

Zone Percentage

Southeast 93.3% Southwest 93.2% Lehigh/Capital 92.4% Northwest 92.4% Northeast 93.3% Total 93.0%

Source: Maximus

36

Medical Assistance Transportation Program

Based on Data Submitted by Each County

37

MATP 1Q FY 18/19

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips Mileage

Reimbursement Trips

Total Trips Client Utilization

Bucks $ 541,632 18,247 - 17,366 35,613 1.1%

Chester $ 570,936 11,205 3,181 5,940 20,326 1.6%

Delaware $ 1,259,087 22,144 5,192 5,262 32,598 0.8%

Montgomery $ 792,399 17,988 3,248 3,957 25,193 1.3%

Philadelphia $ 11,545,940 277,092 760,540 10,121 1,047,753 4.5%

HC-SE Zone $ 14,709,994 346,676 772,161 42,646 1,161,483 3.3%

38

Southwest

MATP 1Q FY 18/19


Reimbursement Trips


Allegheny $ 2,676,073 46,190 153,372 34,556 234,118 4.1%

Armstrong $ 417,494 8,121 - 4,712 12,833 4.8%

Beaver $ 669,140 14,237 283 14,016 28,536 3.3%

Bedford $ 144,152 4,074 - 3,753 7,827 4.0%

Blair $ 349,537 12,386 2,336 2,155 16,877 2.5%

Butler $ 563,232 10,953 - 4,437 15,390 2.6%

Cambria $ 1,024,987 30,238 3,884 4,258 38,380 5.7%

Fayette $ 386,008 16,055 9 21,058 37,122 3.1%

Greene $ 170,276 4,699 - 2,606 7,305 3.6%

Indiana $ 257,210 5,738 821 2,972 9,531 3.3%

Lawrence $ 308,891 7,926 2,918 10,239 21,083 3.2%

Somerset $ 389,998 8,376 - 4,882 13,258 3.9%

Washington $ 634,083 19,070 1,925 10,978 31,973 4.3%

Westmoreland $ 758,785 21,752 109 12,340 34,201 2.8%

HC-SW Zone $ 8,749,864 209,815 165,657 132,962 508,434 3.7%

39

Lehigh/Capital

MATP 1Q FY 18/19


Reimbursement Trips


Adams* $ 50,228 1,546 - 490 2,036 0.9%

Berks $ 804,600 18,874 9,881 4,818 33,573 2.3%

Cumberland $ 159,985 5,100 - 1,385 6,485 1.3%

Dauphin $ 751,035 24,659 5,084 1,172 30,915 2.7%

Franklin $ 128,161 3,873 - 1,322 5,195 1.2%

Fulton $ 106,947 1,485 - 1,084 2,569 6.4%

Huntingdon $ 185,951 3,021 - 5,014 8,035 5.1%

Lancaster $ 688,488 21,841 1,025 5,849 28,715 1.5%

Lebanon $ 447,081 17,874 98 1,188 19,160 1.9%

Lehigh $ 489,177 12,315 1,216 1,364 14,895 0.9%

Northampton $ 221,304 6,439 1,048 1,488 8,975 0.9%

Perry $ 68,361 2,404 - 367 2,771 1.8%

York* $ 274,034 7,793 478 2,837 11,108 0.7%

HC-L/C Zone $ 4,325,123 125,678 18,830 27,888 172,396 1.6%

* As of FY 17-18, the sole source contractor for Adams and York Counties were reported separate. Previously, they had combined reporting. 40

Northwest

MATP 1Q FY 18/19

COUNTY Total Expenditure Para Transit Trips

Mass Transit Trips

Mileage Reimbursement

Trips

Volunteer Trips Total Trips Client

Utilization

Cameron $ 61,150 779 50 271 - 1,100 4.6%

Clarion $ 174,753 2,251 - 2,143 - 4,394 4.2%

Clearfield $ 350,723 9,741 - 5,689 - 15,430 4.9%

Crawford $ 219,165 1,313 758 6,536 4,140 12,747 4.2%

Elk $ 210,755 2,826 1 1,030 - 3,857 4.6%

Erie $ 430,044 15,802 822 2,597 - 19,221 1.2%

Forest $ 42,919 620 - 370 - 990 4.8%

Jefferson $ 382,944 8,379 - 3,494 - 11,873 6.9%

McKean $ 161,287 2,109 14 1,002 - 3,125 3.0%

Mercer $ 242,537 9,924 - 1,705 - 11,629 2.8%

Potter $ 219,015 2,750 - 1,036 - 3,786 7.3%

Venango $ 274,226 4,733 23 1,184 - 5,940 3.5%

Warren $ 93,277 1,275 84 1,845 - 3,204 4.1%

HC-NW Zone $ 2,862,796 62,502 1,752 28,902 4,140 97,296 3.1%

41

Northeast

MATP 1Q FY 18/19

COUNTY Total Expenditure

Para Transit Trips

Mass Transit Trips

Mileage Reimbursement

Trips Total Trips Client Utilization

Bradford/Sullivan/Tioga $ 603,276 6,735 55 2,126 8,916 3.2%

Carbon $ 156,133 2,878 - 496 3,374 2.0%

Centre $ 169,620 4,034 301 1,502 5,837 1.8%

Clinton $ 206,090 3,961 - 514 4,475 4.3%

Columbia $ 108,055 3,349 - 1,031 4,380 2.0%

Juniata $ 32,555 640 - 576 1,216 1.0%

Lackawanna $ 294,207 7,746 2,767 1,909 12,422 1.0%

Luzerne $ 498,279 17,614 1,506 6,436 25,556 1.6%

Lycoming $ 378,213 9,021 1,420 2,048 12,489 3.5%

Mifflin $ 100,897 3,882 - 514 4,396 1.6%

Monroe $ 194,695 5,155 506 4,806 10,467 1.6%

Montour $ 43,888 1,225 - 554 1,779 3.1%

Northumberland $ 293,548 9,019 - 2,880 11,899 3.2%

Pike $ 71,505 1,227 - 1,643 2,870 1.1%

Schuylkill $ 422,504 6,998 379 2,457 9,834 2.2%

Snyder $ 61,724 1,346 - 1,156 2,502 2.4%

Susquehanna $ 151,567 2,475 - 1,642 4,117 3.7%

Union $ 31,627 1,028 - 254 1,282 1.7%

Wayne $ 155,843 3,846 - 1,480 5,326 3.6%

Wyoming $ 79,642 1,563 - 946 2,509 2.7%

HC-NE Zone $ 4,053,868 93,742 6,934 34,970 135,646 2.1%

42

Useful Information

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

43

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

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