BMCO Monthly Physical Health Managed Care Program...

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: November 23, 2016

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 October 2016 ENROLLMENT BY PLAN AND BY COUNTY

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

09 Bucks 5,072 7,267 11,062 38,219 61,620

15 Chester 12,098 7,098 2,396 21,763 43,355

23 Delaware 8,777 11,461 8,202 67,148 95,588

46 Montgomery 9,106 11,546 11,811 52,228 84,691

51 Philadelphia 53,899 37,104 210,076 236,584 537,663

TOTAL 88,952 74,476 243,547 415,942 822,917

PERCENTAGE 11% 9% 30% 51%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

02 Allegheny 59,882 19,398 97,425 6,836 183,541

03 Armstrong 1,163 483 10,198 423 12,267

04 Beaver 11,989 2,155 12,584 1,208 27,936

05 Bedford 773 1,132 5,848 741 8,494

07 Blair 6,959 3,822 12,460 2,143 25,384

10 Butler 5,722 970 13,414 917 21,023

11 Cambria 3,788 5,247 14,484 2,738 26,257

26 Fayette 4,325 9,535 18,978 781 33,619

30 Greene 848 3,536 3,064 381 7,829

32 Indiana 2,655 1,801 8,638 583 13,677

37 Lawrence 7,474 1,404 7,877 702 17,457

56 Somerset 1,965 2,860 6,111 1,050 11,986

63 Washington 5,869 4,938 17,916 1,278 30,001

65 Westmoreland 11,954 7,671 30,351 1,997 51,973

TOTAL 125,366 64,952 259,348 21,778 471,444

PERCENTAGE 26% 14% 55% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16

5


cont. LEHIGH/CAPITAL

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

01 Adams 4,234 4,567 1,117 1,245 1,422 12,585

06 Berks 15,443 8,532 6,049 6,390 39,176 75,590

21 Cumberland 12,104 3,415 3,754 1,289 4,748 25,310

22 Dauphin 28,473 9,819 6,933 4,051 5,476 54,752

28 Franklin 804 709 7,834 496 12,578 22,421

29 Fulton 161 338 724 605 668 2,496

31 Huntingdon 531 648 963 3,576 1,616 7,334

36 Lancaster 23,779 10,144 3,602 8,502 28,567 74,594

38 Lebanon 14,072 1,702 1,643 1,839 3,004 22,260

39 Lehigh 21,482 4,316 4,210 4,334 33,271 67,613

48 Northampton 13,320 2,380 3,245 2,223 22,412 43,580

50 Perry 3,654 566 588 220 876 5,904

67 York 22,171 21,117 6,584 6,378 13,472 69,722

TOTAL 160,228 68,253 47,246 41,148 167,286 484,161

PERCENTAGE 33% 14% 10% 8% 35%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

12 Cameron 811 31 117 48 1,007

16 Clarion 3,969 875 620 663 6,127

17 Clearfield 10,651 1,479 1,973 1,671 15,774

20 Crawford 11,691 961 1,147 1,242 15,041

24 Elk 3,522 464 271 254 4,511

25 Erie 30,825 15,081 6,015 9,531 61,452

27 Forest 532 106 88 54 780

33 Jefferson 6,561 1,015 377 469 8,422

42 McKean 6,014 354 1,260 728 8,356

43 Mercer 13,472 3,850 2,177 2,236 21,735

53 Potter 1,896 50 1,327 85 3,358

61 Venango 6,917 932 1,106 1,130 10,085

62 Warren 4,495 717 793 498 6,503

TOTAL 101,356 25,915 17,271 18,609 163,151

PERCENTAGE 62% 16% 11% 11%


6


cont.

NORTHEAST

County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 2,845 4,484 3,595 10,924

13 Carbon 6,420 2,674 1,179 10,273

14 Centre 2,538 6,278 2,487 11,303

18 Clinton 1,084 5,032 799 6,915

19 Columbia 1,444 6,971 1,161 9,576

34 Juniata 739 1,680 652 3,071

35 Lackawanna 6,876 28,914 5,216 41,006

40 Luzerne 15,852 40,733 10,638 67,223

41 Lycoming 4,998 14,766 1,454 21,218

44 Mifflin 2,018 4,652 1,604 8,274

45 Monroe 13,416 12,488 4,412 30,316

47 Montour 357 1,555 299 2,211

49 Northumberland 3,144 10,042 3,455 16,641

52 Pike 2,824 5,081 1,109 9,014

54 Schuylkill 8,139 14,724 3,261 26,124

55 Snyder 1,129 2,982 923 5,034

57 Sullivan 145 504 132 781

58 Susquehanna 1,116 4,387 923 6,426

59 Tioga 5,949 960 626 7,535

60 Union 969 2,692 778 4,439

64 Wayne 1,519 5,525 1,082 8,126

66 Wyoming 747 3,312 649 4,708

TOTAL 84,268 180,436 46,434 311,138

PERCENTAGE 27% 59% 15%


7

Mandatory October 2016 MARKET SHARE BY PLAN – STATEWIDE

Total Enrollment = 2,252,811

AmeriHealth NE 84,268

4% Aetna

208,543 9%

AmeriHealth 184,557

8%

Gateway 311,509

14%

Health Partners 243,547

11%

Keystone 415,942

18%

United 222,157

10%

UPMC 401,852

18%

Geisinger 180,436

8%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16 8

9

Mandatory October 2016MARKET SHARE BY ZONE AND BY PLAN

Southeast

Aetna74,476

9%

Health Partners243,547

30%

Keystone415,942

50%

United88,952

11%

Lehigh/Capital

Aetna47,246

10%

Ameri-Health

167,28635%Gateway

160,22833%

United68,253

14%

UPMC41,148

8%

Southwest Aetna21,778

5%

Gateway125,366

26%

United64,952

14%

UPMC259,348

55%

Northwest

Aetna18,609

11%

Ameri-Health17,271

11%

Gateway25,915

16%

UPMC101,356

62%

Northeast

Aetna46,434

15%

Ameri-Health NE

84,26827%

Geisinger180,436

58%


Mandatory October 2016 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 588 2,385 4,418 2,116 34,749 44,256

43 Aetna 712 1,215 5,134 2,511 23,280 32,852

45 Health Partners 1,274 416 4,563 3,557 104,473 114,283

47 Keystone 3,955 3,977 32,612 12,080 147,358 199,982

Southeast MCOs 6,529 7,993 46,727 20,264 309,860 391,373

American Indian or

Alaskan Native

42 United 13 28 19 15 62 137

43 Aetna 17 35 11 51 70 184

45 Health Partners 37 16 7 45 238 343

47 Keystone 96 71 106 161 305 739

Southeast MCOs 163 150 143 272 675 1,403

Asian

42 United 221 271 643 538 3,949 5,622

43 Aetna 286 157 555 790 1,530 3,318

45 Health Partners 530 59 357 654 7,371 8,971

47 Keystone 1,302 576 3,868 3,446 17,406 26,598

Southeast MCOs 2,339 1,063 5,423 5,428 30,256 44,509

White

42 United 3,470 6,716 2,830 4,670 7,347 25,033

43 Aetna 5,371 4,534 4,733 6,398 7,064 28,100

45 Health Partners 7,420 1,531 2,341 5,580 33,326 50,198

47 Keystone 27,948 13,345 25,073 27,800 39,577 133,743

Southeast MCOs 44,209 26,126 34,977 44,448 87,314 237,074

Other or system

default

42 United 512 2,049 559 1,258 6,417 10,795

43 Aetna 526 796 637 1,116 4,043 7,118

45 Health Partners 1,316 221 654 1,434 60,908 64,533

47 Keystone 3,676 2,976 4,137 6,757 27,429 44,975

Southeast MCOs 6,030 6,042 5,987 10,565 98,797 127,421

Native Hawaiian or

Other Pacific Islander

42 United 2 13 2 8 49 74

43 Aetna 5 6 13 12 36 72

45 Health Partners 14 0 4 5 131 154

47 Keystone 35 15 37 41 126 254

Southeast MCOs 56 34 56 66 342 554

Unknown

42 United 266 636 306 501 1,326 3,035

43 Aetna 350 355 378 668 1,081 2,832

45 Health Partners 471 153 276 536 3,629 5,065

47 Keystone 1,207 803 1,315 1,943 4,383 9,651

Southeast MCOs 2,294 1,947 2,275 3,648 10,419 20,583

MCO TOTAL

42 United 61,081 43,160 95,079 84,640 533,243 817,203

43 Aetna 7,267 7,098 11,461 11,546 37,104 74,476

45 Health Partners 11,062 2,396 8,202 11,811 210,076 243,547

47 Keystone 38,219 21,763 67,148 52,228 236,584 415,942

TOTAL 61,620 43,355 95,588 84,691 537,663 822,917

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16

10


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

Black or African

American

31 Gateway 28,636 37 2,816 18 446 218 448 406

32 United 8,060 10 420 11 253 14 832 841

34 UPMC 32,525 135 2,040 63 501 330 1,217 1,448

59 Aetna 2,440 7 239 16 128 22 677 86

Southwest MCOs 71,661 189 5,515 108 1,328 584 3,174 2,781

American Indian or

Alaskan Native

31 Gateway 113 2 11 0 5 3 7 11

32 United 40 2 0 1 11 0 2 10

34 UPMC 281 18 25 14 18 27 16 27

59 Aetna 17 0 4 1 8 0 2 3

Southwest MCOs 451 22 40 16 42 30 27 51

Asian

31 Gateway 763 1 29 1 28 27 8 20

32 United 397 2 19 2 21 18 13 12

34 UPMC 4,623 31 98 27 54 146 49 41

59 Aetna 198 0 10 3 11 11 10 3

Southwest MCOs 5,981 34 156 33 114 202 80 76

White

31 Gateway 27,634 1,112 8,861 739 6,388 5,343 3,231 3,812

32 United 9,711 461 1,638 1,104 3,471 892 4,264 8,523

34 UPMC 53,484 9,907 10,022 5,640 11,673 12,496 12,910 17,106

59 Aetna 3,608 410 917 707 1,966 838 1,987 669

Southwest MCOs 94,437 11,890 21,438 8,190 23,498 19,569 22,392 30,110

Other or system

default

31 Gateway 1,712 8 211 11 57 86 68 43

32 United 665 1 55 9 38 24 99 92

34 UPMC 3,767 47 246 81 108 202 177 145

59 Aetna 258 0 24 10 9 17 41 8

Southwest MCOs 6,402 56 536 111 212 329 385 288

Native Hawaiian or


31 Gateway 16 0 5 0 3 3 0 1

32 United 17 0 1 0 1 0 0 0

34 UPMC 57 1 2 5 4 2 2 17

59 Aetna 2 0 0 0 0 0 1 0

Southwest MCOs 92 1 8 5 8 5 3 18

Unknown

31 Gateway 1,008 3 56 4 32 42 26 32

32 United 508 7 22 5 27 22 37 57

34 UPMC 2,688 59 151 18 102 211 113 194

59 Aetna 313 6 14 4 21 29 20 12

Southwest MCOs 4,517 75 243 31 182 304 196 295

MCO TOTAL

31 Gateway 59,882 1,163 9,173 773 6,959 5,722 3,788 4,325

32 United 19,398 483 2,155 1,132 3,822 970 5,247 9,535

34 UPMC 97,425 10,198 12,584 5,848 12,460 13,414 14,484 18,978

59 Aetna 6,836 423 1,208 741 2,143 917 2,738 781

TOTAL 183,541 12,267 27,936 8,494 25,384 21,023 26,257 33,619


11


Southwest cont.

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

Black or African

American

31 Gateway 19 87 998 17 695 1,542 36,383

32 United 41 70 198 17 562 749 12,078

34 UPMC 40 246 804 39 1,523 2,069 42,980

59 Aetna 7 39 112 17 141 154 4,085

Southwest MCOs 107 442 2,112 90 2,921 4,514 95,526

American Indian or

Alaskan Native

31 Gateway 0 2 6 2 6 21 189

32 United 4 11 1 7 10 10 109

34 UPMC 7 5 13 17 35 44 547

59 Aetna 1 1 1 2 6 4 50

Southwest MCOs 12 19 21 28 57 79 895

Asian

31 Gateway 2 24 16 7 17 36 979

32 United 3 5 3 6 13 30 544

34 UPMC 10 56 40 9 105 210 5,499

59 Aetna 4 4 2 2 9 17 284

Southwest MCOs 19 89 61 24 144 293 7,306

White

31 Gateway 817 2,485 6,363 1,905 4,991 10,037 83,718

32 United 3,471 1,665 1,178 2,799 4,192 6,635 50,004

34 UPMC 2,966 8,146 6,883 5,942 15,607 27,073 199,855

59 Aetna 360 510 567 1,006 1,060 1,741 16,346

Southwest MCOs 7,614 12,806 14,991 11,652 25,850 45,486 349,923

Other or system

default

31 Gateway 8 32 45 23 75 183 2,562

32 United 9 26 17 17 82 133 1,267

34 UPMC 25 88 64 44 262 413 5,669

59 Aetna 3 17 8 13 20 34 462

Southwest MCOs 45 163 134 97 439 763 9,960

Native Hawaiian or


31 Gateway 0 0 1 1 0 2 32

32 United 1 2 1 0 4 2 29

34 UPMC 2 2 1 0 5 10 110

59 Aetna 0 0 0 0 0 1 4

Southwest MCOs 3 4 3 1 9 15 175

Unknown

31 Gateway 2 25 45 10 85 133 1,503

32 United 7 22 6 14 75 112 921

34 UPMC 14 95 72 60 379 532 4,688

59 Aetna 6 12 12 10 42 46 547

Southwest MCOs 29 154 135 94 581 823 7,659

MCO TOTAL

31 Gateway 848 2,655 7,474 1,965 5,869 11,954 125,366

32 United 3,536 1,801 1,404 2,860 4,938 7,671 64,952

34 UPMC 3,064 8,638 7,877 6,111 17,916 30,351 259,348

59 Aetna 381 583 702 1,050 1,278 1,997 21,778

TOTAL 7,829 13,677 17,457 11,986 30,001 51,973 471,444


12


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

Black or African

American

51 Gateway 159 1,440 1,431 11,203 68 2 28

52 United 229 765 426 3,748 53 6 19

53 Aetna 57 690 396 2,252 657 13 56

54 UPMC 45 531 105 1,248 43 10 126

57 AmeriHealth 70 3,434 435 1,682 1,062 14 50

Lehigh/Capital MCOs 560 6,860 2,793 20,133 1,883 45 279

American Indian or

Alaskan Native

51 Gateway 13 20 35 76 4 0 0

52 United 8 18 10 25 2 0 0

53 Aetna 3 5 9 31 19 2 0

54 UPMC 4 17 1 6 4 2 0

57 AmeriHealth 3 45 10 24 41 3 1

Lehigh/Capital MCOs 31 105 65 162 70 7 1

Asian

51 Gateway 33 167 330 1,484 2 0 1

52 United 27 131 128 442 2 0 1

53 Aetna 7 105 108 247 43 1 3

54 UPMC 10 86 34 192 0 0 14

57 AmeriHealth 9 279 100 187 106 0 1

Lehigh/Capital MCOs 86 768 700 2,552 153 1 20

White

51 Gateway 3,710 7,256 8,645 8,998 619 154 488

52 United 3,610 4,833 2,248 3,550 599 326 614

53 Aetna 938 3,668 2,800 3,226 6,255 695 891

54 UPMC 1,051 3,675 960 1,920 409 592 3,379

57 AmeriHealth 1,222 13,369 3,584 2,294 9,348 635 1,538

Lehigh/Capital MCOs 10,531 32,801 18,237 19,988 17,230 2,402 6,910

Other or system

default

51 Gateway 212 6,223 1,251 5,822 63 1 13

52 United 575 2,516 438 1,626 29 5 10

53 Aetna 80 1,387 262 851 579 11 8

54 UPMC 76 1,840 125 498 21 0 43

57 AmeriHealth 72 21,189 419 981 1,418 12 15

Lehigh/Capital MCOs 1,015 33,155 2,495 9,778 2,110 29 89

Native Hawaiian or

Other Pacific

Islander

51 Gateway 1 2 10 23 0 0 0

52 United 3 10 3 7 0 0 0

53 Aetna 1 4 2 7 7 0 0

54 UPMC 2 4 1 2 0 1 2

57 AmeriHealth 0 22 7 5 13 1 1


Unknown

51 Gateway 106 335 402 867 48 4 1

52 United 115 259 162 421 24 1 4

53 Aetna 31 190 177 319 274 2 5

54 UPMC 57 237 63 185 19 0 12

57 AmeriHealth 46 838 193 303 590 3 10

Lehigh/Capital MCOs 355 1,859 997 2,095 955 10 32

MCO TOTAL

51 Gateway 4,234 15,443 12,104 28,473 804 161 531

52 United 4,567 8,532 3,415 9,819 709 338 648

53 Aetna 1,117 6,049 3,754 6,933 7,834 724 963

54 UPMC 1,245 6,390 1,289 4,051 496 605 3,576

57 AmeriHealth 1,422 39,176 4,748 5,476 12,578 668 1,616

TOTAL 12,585 75,590 25,310 54,752 22,421 2,496 7,334

13

Racial/Ethnic

information is self-

reported by consumers.



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

Black or African

American

51 Gateway 2,003 596 2,954 1,835 44 2,437 24,200

52 United 1,201 93 615 284 12 3,848 11,299

53 Aetna 423 82 713 435 22 1,047 6,843

54 UPMC 763 109 597 261 9 943 4,790

57 AmeriHealth 3,216 165 3,702 2,380 10 2,193 18,413

Lehigh/Capital MCOs 7,606 1,045 8,581 5,195 97 10,468 65,545

American Indian or

Alaskan Native

51 Gateway 35 11 32 36 2 76 340

52 United 28 0 8 3 0 45 147

53 Aetna 23 1 4 9 1 17 124

54 UPMC 29 4 8 5 0 26 106

57 AmeriHealth 51 5 49 46 0 51 329

Lehigh/Capital MCOs 166 21 101 99 3 215 1,046

Asian

51 Gateway 991 106 287 192 7 217 3,817

52 United 292 27 88 53 4 224 1,419

53 Aetna 106 16 114 85 5 97 937

54 UPMC 288 15 120 63 0 68 890

57 AmeriHealth 702 52 570 433 0 159 2,598

Lehigh/Capital MCOs 2,379 216 1,179 826 16 765 9,661

White

51 Gateway 15,158 9,611 15,203 7,802 3,498 16,227 97,369

52 United 5,779 1,202 3,048 1,644 524 12,027 40,004

53 Aetna 2,244 1,199 2,835 2,236 537 4,371 31,895

54 UPMC 5,460 1,294 3,022 1,483 198 4,236 27,679

57 AmeriHealth 14,697 1,692 24,567 14,329 838 8,219 96,332


Other or system

default

51 Gateway 4,735 3,423 2,667 3,167 74 2,741 30,392

52 United 2,424 324 402 303 18 4,467 13,137

53 Aetna 608 296 399 334 13 789 5,617

54 UPMC 1,448 352 431 292 9 849 5,984

57 AmeriHealth 8,729 970 3,794 4,696 19 2,475 44,789


Native Hawaiian or

Other Pacific

Islander

51 Gateway 2 9 7 11 0 12 77

52 United 9 1 11 3 1 19 67

53 Aetna 6 1 11 7 0 4 50

54 UPMC 5 0 10 5 0 2 34

57 AmeriHealth 22 4 24 17 0 13 129


Unknown

51 Gateway 855 316 332 277 29 461 4,033

52 United 411 55 144 90 7 487 2,180

53 Aetna 192 48 134 139 10 259 1,780

54 UPMC 509 65 146 114 4 254 1,665

57 AmeriHealth 1,150 116 565 511 9 362 4,696

Lehigh/Capital MCOs 3,117 600 1,321 1,131 59 1,823 14,354

MCO TOTAL

51 Gateway 23,779 14,072 21,482 13,320 3,654 22,171 160,228

52 United 10,144 1,702 4,316 2,380 566 21,117 68,253

53 Aetna 3,602 1,643 4,210 3,245 588 6,584 47,246

54 UPMC 8,502 1,839 4,334 2,223 220 6,378 41,148

57 AmeriHealth 28,567 3,004 33,271 22,412 876 13,472 167,286

TOTAL 74,594 22,260 67,613 43,580 5,904 69,722 484,161

Racial/Ethnic information is

self-reported by consumers.


14


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

Black or African

American

35 UPMC 21 100 110 398 33 4,698 3

36 Gateway 1 25 24 40 6 3,814 1

37 AmeriHealth 3 16 32 37 3 1,343 0

56 Aetna 1 24 21 51 2 2,263 0

New West MCOs 26 165 187 526 44 12,118 4

American Indian or

Alaskan Native

35 UPMC 1 8 5 20 10 87 2

36 Gateway 0 0 0 2 0 34 4

37 AmeriHealth 0 2 2 1 3 11 0

56 Aetna 1 1 0 0 0 33 0

New West MCOs 2 11 7 23 13 165 6

Asian

35 UPMC 2 16 48 34 4 1,478 0

36 Gateway 0 4 2 0 2 250 0

37 AmeriHealth 0 8 9 1 0 178 0

56 Aetna 0 4 7 0 1 113 0

New West MCOs 2 32 66 35 7 2,019 0

White

35 UPMC 780 3,781 10,394 11,070 3,442 22,708 522

36 Gateway 30 834 1,438 905 455 9,935 100

37 AmeriHealth 113 582 1,913 1,092 260 4,156 87

56 Aetna 46 626 1,618 1,183 251 6,521 53

New West MCOs 969 5,823 15,363 14,250 4,408 43,320 762

Other or system

default

35 UPMC 5 25 44 82 16 1,529 3

36 Gateway 0 6 9 4 0 930 1

37 AmeriHealth 1 5 9 5 5 267 1

56 Aetna 0 4 10 4 0 516 1

New West MCOs 6 40 72 95 21 3,242 6

Native Hawaiian or


35 UPMC 0 1 1 6 1 12 0

36 Gateway 0 0 0 0 0 7 0

37 AmeriHealth 0 0 0 0 0 1 0

56 Aetna 0 1 1 0 0 2 0

New West MCOs 0 2 2 6 1 22 0

Unknown

35 UPMC 2 38 49 81 16 313 2

36 Gateway 0 6 6 10 1 111 0

37 AmeriHealth 0 7 8 11 0 59 0

56 Aetna 0 3 14 4 0 83 0

New West MCOs 2 54 77 106 17 566 2

MCO TOTAL

35 UPMC 811 3,969 10,651 11,691 3,522 30,825 532

36 Gateway 31 875 1,479 961 464 15,081 106

37 AmeriHealth 117 620 1,973 1,147 271 6,015 88

56 Aetna 48 663 1,671 1,242 254 9,531 54

TOTAL 1,007 6,127 15,774 15,041 4,511 61,452 780Racial/Ethnic information is self-reported by consumers.


15


Northwest cont.

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

Black or African

American

35 UPMC 60 63 1,722 10 164 35 7,417

36 Gateway 9 6 718 1 30 10 4,685

37 AmeriHealth 11 7 441 14 30 7 1,944

56 Aetna 6 4 454 0 40 6 2,872

New West MCOs 86 80 3,335 25 264 58 16,918

American Indian or

Alaskan Native

35 UPMC 11 13 8 4 10 13 192

36 Gateway 1 2 3 0 5 1 52

37 AmeriHealth 1 5 6 2 3 1 37

56 Aetna 1 1 1 0 2 2 42

New West MCOs 14 21 18 6 20 17 323

Asian

35 UPMC 17 21 80 3 21 16 1,740

36 Gateway 5 0 18 0 5 0 286

37 AmeriHealth 2 9 19 0 3 2 231

56 Aetna 0 0 15 0 2 2 144

New West MCOs 24 30 132 3 31 20 2,401

White

35 UPMC 6,418 5,863 11,343 1,852 6,631 4,395 89,199

36 Gateway 995 341 3,036 48 876 699 19,692

37 AmeriHealth 358 1,228 1,657 1,295 1,054 774 14,569

56 Aetna 456 719 1,716 83 1,071 481 14,824

New West MCOs 8,227 8,151 17,752 3,278 9,632 6,349 138,284

Other or system

default

35 UPMC 35 33 161 12 47 22 2,014

36 Gateway 5 4 43 0 8 2 1,012

37 AmeriHealth 3 5 30 9 11 5 356

56 Aetna 4 2 20 0 11 4 576

New West MCOs 47 44 254 21 77 33 3,958

Native Hawaiian or


35 UPMC 1 3 5 0 2 1 33

36 Gateway 0 0 1 0 0 0 8

37 AmeriHealth 0 3 1 1 1 1 8

56 Aetna 0 0 0 0 0 0 4

New West MCOs 1 6 7 1 3 2 53

Unknown

35 UPMC 19 18 153 15 42 13 761

36 Gateway 0 1 31 1 8 5 180

37 AmeriHealth 2 3 23 6 4 3 126

56 Aetna 2 2 30 2 4 3 147

New West MCOs 23 24 237 24 58 24 1,214

MCO TOTAL

35 UPMC 6,561 6,014 13,472 1,896 6,917 4,495 101,356

36 Gateway 1,015 354 3,850 50 932 717 25,915

37 AmeriHealth 377 1,260 2,177 1,327 1,106 793 17,271

56 Aetna 469 728 2,236 85 1,130 498 18,609

TOTAL 8,422 8,356 21,735 3,358 10,085 6,503 163,151


16


Northeast

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

Black or African American

41 AmeriHealth NE 34 190 121 20 79 12 774 1,801

44 Geisinger 58 97 262 82 215 16 2,237 3,912

50 Aetna Better Health 48 46 141 27 64 14 631 1,323

New East MCOs 140 333 524 129 358 42 3,642 7,036

American Indian or Alaskan

Native

41 AmeriHealth NE 6 10 4 2 8 2 14 26

44 Geisinger 7 4 24 6 10 0 56 41

50 Aetna Better Health 4 3 15 2 3 2 8 7

New East MCOs 17 17 43 10 21 4 78 74

Asian

41 AmeriHealth NE 10 14 67 4 13 0 209 100

44 Geisinger 20 15 147 13 37 7 1,001 346


New East MCOs 47 32 312 17 63 9 1,423 536

White

41 AmeriHealth NE 2,756 5,941 2,247 1,038 1,291 663 4,854 9,581

44 Geisinger 4,357 2,426 5,669 4,831 6,546 1,504 21,482 29,528

50 Aetna Better Health 3,484 1,048 2,125 747 1,024 595 3,645 6,670

New East MCOs 10,597 9,415 10,041 6,616 8,861 2,762 29,981 45,779

Other or system default

41 AmeriHealth NE 24 185 61 11 36 49 906 4,136

44 Geisinger 26 98 85 55 98 138 3,655 6,354

50 Aetna Better Health 27 57 52 13 39 29 598 2,375

New East MCOs 77 340 198 79 173 216 5,159 12,865

Native Hawaiian or Other

Pacific Islander

41 AmeriHealth NE 1 2 0 0 0 0 3 4

44 Geisinger 0 0 4 2 1 0 14 22


New East MCOs 2 4 7 2 2 1 20 34

Unknown

41 AmeriHealth NE 14 78 38 9 17 13 116 204

44 Geisinger 16 34 87 43 64 15 469 530


New East MCOs 44 132 178 62 98 37 703 899

MCO TOTAL

41 AmeriHealth NE 2,845 6,420 2,538 1,084 1,444 739 6,876 15,852

44 Geisinger 4,484 2,674 6,278 5,032 6,971 1,680 28,914 40,733

50 Aetna Better Health 3,595 1,179 2,487 799 1,161 652 5,216 10,638

TOTAL 10,924 10,273 11,303 6,915 9,576 3,071 41,006 67,223

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

Black or African

American

41 AmeriHealth NE 894 47 2,259 17 165 346 311 38 44 Geisinger 2,025 86 2,249 37 353 328 516 95 50 Aetna Better Health 196 35 1,044 5 174 107 126 22 New East MCOs 3,115 168 5,552 59 692 781 953 155

American Indian or

Alaskan Native

41 AmeriHealth NE 5 5 24 0 11 10 13 2 44 Geisinger 28 7 34 4 14 12 18 3 50 Aetna Better Health 1 0 13 1 5 4 9 2 New East MCOs 34 12 71 5 30 26 40 7

Asian


White

41 AmeriHealth NE 3,957 1,928 8,330 330 2,734 2,086 7,298 1,031 44 Geisinger 12,405 4,453 7,594 1,442 9,140 4,309 13,434 2,765 50 Aetna Better Health 1,206 1,516 2,334 279 3,109 845 2,955 865 New East MCOs 17,568 7,897 18,258 2,051 14,983 7,240 23,687 4,661


41 AmeriHealth NE 66 27 2,217 5 182 280 400 31 44 Geisinger 153 78 2,064 37 359 279 546 73 50 Aetna Better Health 18 34 795 6 115 114 134 15 New East MCOs 237 139 5,076 48 656 673 1,080 119

Native Hawaiian or



Unknown


MCO TOTAL

41 AmeriHealth NE 4,998 2,018 13,416 357 3,144 2,824 8,139 1,129

44 Geisinger 14,766 4,652 12,488 1,555 10,042 5,081 14,724 2,982

50 Aetna Better Health 1,454 1,604 4,412 299 3,455 1,109 3,261 923

TOTAL 21,218 8,274 30,316 2,211 16,641 9,014 26,124 5,034



18


Northeast cont.

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

Black or African American

41 AmeriHealth NE 1 4 96 42 39 9 7,299

44 Geisinger 5 29 17 181 103 24 12,927

50 Aetna Better Health 7 11 16 44 31 8 4,120

New East MCOs 13 44 129 267 173 41 24,346

American Indian or Alaskan

Native

41 AmeriHealth NE 1 0 12 0 4 0 159

44 Geisinger 1 2 2 4 20 3 300

50 Aetna Better Health 0 0 1 1 2 1 84

New East MCOs 2 2 15 5 26 4 543

Asian

41 AmeriHealth NE 1 2 17 5 10 0 753

44 Geisinger 1 14 5 19 31 10 2,114


New East MCOs 2 18 22 24 46 12 3,441

White

41 AmeriHealth NE 138 1,096 5,760 886 1,425 723 66,093

44 Geisinger 493 4,278 915 2,390 5,206 3,221 148,388


New East MCOs 755 6,270 7,267 3,991 7,630 4,571 250,881


41 AmeriHealth NE 4 11 42 29 31 9 8,742

44 Geisinger 4 29 8 81 100 28 14,348


New East MCOs 9 51 59 120 155 45 27,574

Native Hawaiian or Other

Pacific Islander

41 AmeriHealth NE 0 0 1 0 0 1 54

44 Geisinger 0 1 1 1 2 1 99


New East MCOs 0 1 3 1 2 2 190

Unknown

41 AmeriHealth NE 0 3 21 7 10 5 1,168

44 Geisinger 0 34 12 16 63 25 2,260


New East MCOs 0 40 40 31 94 33 4,163

MCO TOTAL

41 AmeriHealth NE 145 1,116 5,949 969 1,519 747 84,268

44 Geisinger 504 4,387 960 2,692 5,525 3,312 180,436

50 Aetna Better Health 132 923 626 778 1,082 649 46,434

TOTAL 781 6,426 7,535 4,439 8,126 4,708 311,138



19

Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 42 63 36 60 161 362

43 Aetna 45 34 37 59 172 347

45 Health Partners 44 38 39 68 238 427

47 Keystone 115 42 80 158 273 668

Southeast MCOs 246 177 192 345 844 1,804

Non-Hispanic

42 United 4,479 8,991 8,278 7,841 47,648 77,237

43 Aetna 6,651 5,915 10,870 10,629 33,041 67,106

45 Health Partners 9,576 2,076 7,563 10,492 144,991 174,698

47 Keystone 34,178 17,673 63,687 46,384 210,804 372,726

Southeast MCOs 54,884 34,655 90,398 75,346 436,484 691,767

Hispanic

42 United 551 3,044 463 1,205 6,090 11,353

43 Aetna 571 1,149 554 858 3,891 7,023

45 Health Partners 1,442 282 600 1,251 64,847 68,422

47 Keystone 3,926 4,048 3,381 5,686 25,507 42,548

Southeast MCOs 6,490 8,523 4,998 9,000 100,335 129,346

TOTAL 61,620 43,355 95,588 84,691 537,663 822,917



20


Southwest

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

Other/Unknown

31 Gateway 82 1 5 1 3 9 4 7

32 United 95 2 8 2 3 4 6 8

34 UPMC 294 7 12 8 26 36 16 28

59 Aetna 62 1 2 3 2 10 3 3

Southwest MCOs 533 11 27 14 34 59 29 46

Non-Hispanic

31 Gateway 58,993 1,150 11,851 764 6,880 5,594 3,726 4,284

32 United 18,990 480 2,114 1,124 3,767 938 5,147 9,464

34 UPMC 95,078 10,125 12,413 5,773 12,284 13,150 14,314 18,783

59 Aetna 6,636 421 1,185 727 2,115 889 2,694 767

Southwest MCOs 179,697 12,176 27,563 8,388 25,046 20,571 25,881 33,298

Hispanic

31 Gateway 807 12 133 8 76 119 58 34

32 United 313 1 33 6 52 28 94 63

34 UPMC 2,053 66 159 67 150 228 154 167

59 Aetna 138 1 21 11 26 18 41 11

Southwest MCOs 3,311 80 346 92 304 393 347 275

TOTAL 183,541 12,267 27,936 8,494 25,384 21,023 26,257 33,619



21


Southwest cont.

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

Other/Unknown

31 Gateway 1 3 1 0 7 17 141

32 United 5 14 1 1 6 22 177

34 UPMC 5 18 5 3 25 51 534

59 Aetna 0 5 2 0 4 9 106

Southwest MCOs 11 40 9 4 42 99 958

Non-Hispanic

31 Gateway 844 2,628 7,425 1,944 5,788 11,822 123,693

32 United 3,520 1,763 1,386 2,834 4,867 7,555 63,949

34 UPMC 3,038 8,536 7,771 6,051 17,645 29,971 254,932

59 Aetna 379 562 694 1,036 1,256 1,945 21,306

Southwest MCOs 7,781 13,489 17,276 11,865 29,556 51,293 463,880

Hispanic

31 Gateway 3 24 48 21 74 115 1,532

32 United 11 24 17 25 65 94 826

34 UPMC 21 84 101 57 246 329 3,882

59 Aetna 2 16 6 14 18 43 366

Southwest MCOs 37 148 172 117 403 581 6,606

TOTAL 7,829 13,677 17,457 11,986 30,001 51,973 471,444



22


Lehigh/Capital

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

Other/Unknown

51 Gateway 6 16 25 52 7 4 4

52 United 9 18 18 62 2 0 0

53 Aetna 5 34 26 34 19 0 0

54 UPMC 4 25 5 23 12 0 4

57 AmeriHealth 4 43 24 25 41 1 0


Non-Hispanic

51 Gateway 3,898 8,490 11,272 22,543 733 155 511

52 United 3,667 5,759 3,058 8,206 671 335 638

53 Aetna 979 4,457 3,519 6,140 7,242 709 954

54 UPMC 1,090 4,274 1,198 3,592 458 601 3,534

57 AmeriHealth 1,288 15,826 4,386 4,429 10,762 656 1,605


Hispanic

51 Gateway 330 6,937 807 5,878 64 2 16

52 United 891 2,755 339 1,551 36 3 10

53 Aetna 133 1,558 209 759 573 15 9

54 UPMC 151 2,091 86 436 26 4 38

57 AmeriHealth 130 23,307 338 1,022 1,775 11 11

Lehigh/Capital MCOs 1,635 36,648 1,779 9,646 2,474 35 84

TOTAL 12,585 75,590 25,310 54,752 22,421 2,496 7,334



23


Lehigh/Capital cont.

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

Other/Unknown

51 Gateway 33 5 22 26 7 34 241

52 United 28 3 21 20 1 61 243

53 Aetna 18 4 21 22 1 43 227

54 UPMC 39 8 21 23 1 36 201

57 AmeriHealth 57 6 68 56 2 36 363

Lehigh/Capital MCOs 175 26 153 147 12 210 1,275

Non-Hispanic

51 Gateway 18,578 9,269 10,097 8,831 3,547 19,338 117,262

52 United 7,365 1,237 2,475 1,956 549 16,131 52,047

53 Aetna 2,902 1,242 2,649 2,729 569 5,695 39,786

54 UPMC 6,799 1,330 2,831 1,760 209 5,389 33,065

57 AmeriHealth 18,316 1,624 17,061 15,880 860 10,609 103,302


Hispanic

51 Gateway 5,168 4,798 11,363 4,463 100 2,799 42,725

52 United 2,751 462 1,820 404 16 4,925 15,963

53 Aetna 682 397 1,540 494 18 846 7,233

54 UPMC 1,664 501 1,482 440 10 953 7,882

57 AmeriHealth 10,194 1,374 16,142 6,476 14 2,827 63,621


TOTAL 74,594 22,260 67,613 43,580 5,904 69,722 484,161



24


Northwest

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

Other/Unknown

35 UPMC 0 7 6 14 1 44 2

36 Gateway 0 2 1 0 1 6 0

37 AmeriHealth 0 6 0 4 0 6 0

56 Aetna 0 1 3 3 0 6 0

New West MCOs 0 16 10 21 2 62 2

Non-Hispanic

35 UPMC 792 3,929 10,578 11,559 3,492 28,930 529

36 Gateway 30 871 1,471 954 461 13,770 102

37 AmeriHealth 116 611 1,951 1,136 266 5,659 88

56 Aetna 47 653 1,656 1,224 251 8,855 54

New West MCOs 985 6,064 15,656 14,873 4,470 57,214 773

Hispanic

35 UPMC 19 33 67 118 29 1,851 1

36 Gateway 1 2 7 7 2 1,305 4

37 AmeriHealth 1 3 22 7 5 350 0

56 Aetna 1 9 12 15 3 670 0

New West MCOs 22 47 108 147 39 4,176 5

TOTAL 1,007 6,127 15,774 15,041 4,511 61,452 780



25


Northwest cont.

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

Other/Unknown

35 UPMC 6 3 33 6 6 5 133

36 Gateway 0 0 7 0 1 0 18

37 AmeriHealth 0 0 12 1 1 0 30

56 Aetna 2 0 4 0 1 1 21

New West MCOs 8 3 56 7 9 6 202

Non-Hispanic

35 UPMC 6,496 5,934 13,294 1,874 6,831 4,469 98,707

36 Gateway 1,011 349 3,805 47 923 706 24,500

37 AmeriHealth 375 1,254 2,135 1,318 1,088 785 16,782

56 Aetna 466 726 2,200 85 1,113 497 17,827

New West MCOs 8,348 8,263 21,434 3,324 9,955 6,457 157,816

Hispanic

35 UPMC 59 77 145 16 80 21 2,516

36 Gateway 4 5 38 3 8 11 1,397

37 AmeriHealth 2 6 30 8 17 8 459

56 Aetna 1 2 32 0 16 0 761

New West MCOs 66 90 245 27 121 40 5,133

TOTAL 8,422 8,356 21,735 3,358 10,085 6,503 163,151



26


Northeast

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

Other/Unknown

41 AmeriHealth NE 5 9 13 1 5 2 17 36

44 Geisinger 8 8 21 13 4 3 69 67

50 Aetna 2 4 19 1 1 1 34 30

New East MCOs 15 21 53 15 10 6 120 133

Non-Hispanic

41 AmeriHealth NE 2,801 5,969 2,463 1,066 1,366 683 5,729 11,006

44 Geisinger 4,417 2,503 6,122 4,944 6,765 1,525 24,433 32,989

50 Aetna 3,563 1,089 2,399 781 1,098 612 4,424 7,780

New East MCOs 10,781 9,561 10,984 6,791 9,229 2,820 34,586 51,775

Hispanic

41 AmeriHealth NE 39 442 62 17 73 54 1,130 4,810

44 Geisinger 59 163 135 75 202 152 4,412 7,677

50 Aetna 30 86 69 17 62 39 758 2,828

New East MCOs 128 691 266 109 337 245 6,300 15,315

TOTAL 10,924 10,273 11,303 6,915 9,576 3,071 41,006 67,223




Northeast cont.

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

Other/Unknown

41 AmeriHealth

NE 17 1 23 0 12 13 8 4

44 Geisinger 31 2 36 2 16 18 6 5

50 Aetna 8 1 23 1 3 1 11 5

New East MCOs 56 4 82 3 31 32 25 14

Non-Hispanic

41 AmeriHealth

NE 4,876 1,954 10,997 346 2,864 2,386 7,406 1,084

44 Geisinger 14,537 4,517 10,203 1,499 9,413 4,613 13,742 2,883

50 Aetna 1,417 1,540 3,446 287 3,280 946 3,039 903

New East MCOs 20,830 8,011 24,646 2,132 15,557 7,945 24,187 4,870

Hispanic

41 AmeriHealth

NE 105 63 2,396 11 268 425 725 41

44 Geisinger 198 133 2,249 54 613 450 976 94

50 Aetna 29 63 943 11 172 162 211 15

New East MCOs 332 259 5,588 76 1,053 1,037 1,912 150

TOTAL 21,218 8,274 30,316 2,211 16,641 9,014 26,124 5,034



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 2 4 1 175

44 Geisinger 1 8 0 7 14 13 352

50 Aetna 0 0 2 4 3 1 155

New East MCOs 1 8 4 13 21 15 682

Non-Hispanic

41 AmeriHealth NE 136 1,099 5,895 891 1,460 734 73,211

44 Geisinger 490 4,290 955 2,514 5,287 3,244 161,885

50 Aetna 129 906 614 734 1,033 641 40,661

New East MCOs 755 6,295 7,464 4,139 7,780 4,619 275,757

Hispanic

41 AmeriHealth NE 9 17 52 76 55 12 10,882

44 Geisinger 13 89 5 171 224 55 18,199

50 Aetna 3 17 10 40 46 7 5,618

New East MCOs 25 123 67 287 325 74 34,699

TOTAL 781 6,426 7,535 4,439 8,126 4,708 311,138



29

Mandatory October 2016 PLAN MAKE UP BY AGE GROUP AND GENDER

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs

Female 22,614 18,401 59,648 112,635 213,298

Male 23,457 19,610 60,496 120,245 223,808

Total 46,071 38,011 120,144 232,880 437,106

22-45 Yrs

Female 16,259 13,857 51,200 77,308 158,624

Male 12,596 12,235 27,811 42,060 94,702

Total 28,855 26,092 79,011 119,368 253,326

46-64 Yrs

Female 6,627 4,523 23,885 33,766 68,801

Male 6,809 5,442 19,107 27,642 59,000

Total 13,436 9,965 42,992 61,408 127,801

Over 64

Yrs

Female 360 256 906 1,433 2,955

Male 230 152 494 853 1,729

Total 590 408 1,400 2,286 4,684

TOTAL 88,952 74,476 243,547 415,942 822,917

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs Female 32,940 16,920 62,103 4,675 116,638

Male 35,096 18,038 65,304 4,709 123,147

Total 68,036 34,958 127,407 9,384 239,785

22-45 Yrs Female 24,689 12,078 53,134 4,513 94,414

Male 13,357 8,432 32,480 4,211 58,480

Total 38,046 20,510 85,614 8,724 152,894

46-64 Yrs Female 10,924 4,983 25,484 1,706 43,097

Male 8,087 4,356 20,133 1,911 34,487

Total 19,011 9,339 45,617 3,617 77,584

Over 64

Yrs

Female 157 86 433 30 706

Male 116 59 277 23 475

Total 273 145 710 53 1,181

TOTAL 125,366 64,952 259,348 21,778 471,444



LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs

Female 46,455 19,655 11,784 9,799 46,920 134,613

Male 48,797 20,560 12,398 10,440 49,102 141,297

Total 95,252 40,215 24,182 20,239 96,022 275,910

22-45 Yrs

Female 30,888 12,395 9,764 8,800 32,825 94,672

Male 14,517 7,358 6,653 5,898 15,867 50,293

Total 45,405 19,753 16,417 14,698 48,692 144,965

46-64 Yrs

Female 11,052 4,405 3,347 3,238 13,024 35,066

Male 7,898 3,616 3,113 2,814 8,788 26,229

Total 18,950 8,021 6,460 6,052 21,812 61,295

Over 64

Yrs

Female 401 158 115 100 515 1,289

Male 220 106 72 59 245 702

Total 621 264 187 159 760 1,991

TOTAL 160,228 68,253 47,246 41,148 167,286 484,161

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs Female 26,152 6,610 3,962 4,832 41,556

Male 27,637 6,962 4,046 5,010 43,655

Total 53,789 13,572 8,008 9,842 85,211

22-45 Yrs Female 20,238 5,212 3,592 3,550 32,592

Male 11,954 3,413 2,765 2,554 20,686

Total 32,192 8,625 6,357 6,104 53,278

46-64 Yrs Female 8,844 2,008 1,442 1,425 13,719

Male 6,346 1,673 1,430 1,211 10,660

Total 15,190 3,681 2,872 2,636 24,379

Over 64

Yrs

Female 110 21 25 17 173

Male 75 16 9 10 110

Total 185 37 34 27 283

TOTAL 101,356 25,915 17,271 18,609 163,151


31


NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs Female 21,461 46,955 12,002 80,418

Male 22,621 49,351 12,723 84,695

Total 44,082 96,306 24,725 165,113

22-45 Yrs Female 17,530 36,155 8,902 62,587

Male 10,110 20,170 6,297 36,577

Total 27,640 56,325 15,199 99,164

46-64 Yrs Female 6,993 15,752 3,509 26,254

Male 5,338 11,620 2,873 19,831

Total 12,331 27,372 6,382 46,085

Over 64 Yrs Female 148 263 83 494

Male 67 170 45 282

Total 215 433 128 776

TOTAL 84,268 180,436 46,434 311,138


Mandatory October 2016 PLAN MAKE UP BY AGE GROUP

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs 46,071 38,011 120,144 232,880 437,106

22-45 Yrs 28,855 26,092 79,011 119,368 253,326

46-64 Yrs 13,436 9,965 42,992 61,408 127,801

Over 64 Yrs 590 408 1,400 2,286 4,684

TOTAL 88,952 74,476 243,547 415,942 822,917

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs 68,036 34,958 127,407 9,384 239,785

22-45 Yrs 38,046 20,510 85,614 8,724 152,894

46-64 Yrs 19,011 9,339 45,617 3,617 77,584

Over 64 Yrs 273 145 710 53 1,181

TOTAL 125,366 64,952 259,348 21,778 471,444

LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs 95,252 40,215 24,182 20,239 96,022 275,910

22-45 Yrs 45,405 19,753 16,417 14,698 48,692 144,965

46-64 Yrs 18,950 8,021 6,460 6,052 21,812 61,295

Over 64 Yrs 621 264 187 159 760 1,991

TOTAL 160,228 68,253 47,246 41,148 167,286 484,161


33

Mandatory October 2016 PLAN MAKE UP BY AGE GROUP

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 53,789 13,572 8,008 9,842 85,211

22-45 Yrs 32,192 8,625 6,357 6,104 53,278

46-64 Yrs 15,190 3,681 2,872 2,636 24,379

Over 64 Yrs 185 37 34 27 283

TOTAL 101,356 25,915 17,271 18,609 163,151

NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs 44,082 96,306 24,725 165,113

22-45 Yrs 27,640 56,325 15,199 99,164

46-64 Yrs 12,331 27,372 6,382 46,085

Over 64 Yrs 215 433 128 776

TOTAL 84,268 180,436 46,434 311,138


34

HealthChoices Enrollment 1st Quarter 2016 AID CATEGORY DISTRIBUTION

Southeast

Newly Eligible (19-20)

2%

TANF/HB/MAGI (Ages 21+)

11%

Newly Eligible (21+) 24%

SSI & HH 19%

TANF/HB/MAGI (Ages 0-20)

44%

B&CC <1%

Southwest B&CC <1%


3%


11%


SSI & HH 20%


41%

Lehigh/Capital B&CC <1%


11%


SSI & HH 16%


47%


2%

Northeast B&CC <1%


3%


11%


SSI & HH 17%


44%

Northwest B&CC <1%


3% 35


11%


SSI & HH 20%


42%

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.

HealthChoices Enrollment October 2016 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.

October 2016

Zone Percentage

Southeast 93.8%

Southwest 94.6%

Lehigh/Capital 93.5%

Northwest 95.0%

Northeast 93.5%

Total 93.9%

Source: Maximus

36

Medical Assistance Transportation Program

Based on Data Submitted by Each County

37

MATP 4Q FY 14/15

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips

Mileage

Reimbursement

Trips

Total Trips Client Utilization

Bucks $ 586,793 20,603 - 12,096 32,699 6.6%

Chester $ 566,831 15,944 1,884 2,310 20,138 8.3%

Delaware $ 1,309,706 34,490 - 11,796 46,286 4.3%

Montgomery $ 629,167 21,004 - 7,251 28,255 7.5%

Philadelphia $ 9,560,604 284,893 835,468 17,552 1,137,913 2.0%

HC-SE Zone $ 12,653,101 376,934 837,352 51,005 1,265,291 5.7%

38

MATP 4Q FY 14/15

Southwest


Mileage

Reimbursement

Trips


Allegheny $ 2,026,576 48,432 137,994 33,333 219,759 6.7%

Armstrong $ 467,523 10,720 - 6,550 17,270 7.9%

Beaver $ 442,233 11,250 314 21,698 33,262 4.4%

Bedford $ 119,716 10,797 - 5,309 16,106 4.9%

Blair $ 244,883 12,243 1,957 4,928 19,128 7.7%

Butler $ 574,807 14,651 - 2,544 17,195 9.6%

Cambria $ 879,835 27,756 4,525 4,274 36,555 8.0%

Fayette $ 294,768 15,199 322 15,035 30,556 5.8%

Greene $ 161,470 4,940 - 2,601 7,541 9.0%

Indiana $ 298,475 7,952 414 5,632 13,998 8.3%

Lawrence $ 244,172 7,349 322 15,361 23,032 5.4%

Somerset $ 218,953 5,166 - 7,868 13,034 7.1%

Washington $ 550,995 20,196 682 14,254 35,132 6.6%

Westmoreland $ 495,833 17,443 196 18,141 35,780 7.3%

HC-SW Zone $ 7,020,239 214,094 146,726 157,528 518,348 7.1%

39

MATP 4Q FY 14/15

Lehigh/Capital


Mileage

Reimbursement

Trips


Berks $ 555,323 21,742 12,652 5,544 39,938 9.3%

Cumberland $ 101,421 5,163 340 2,162 7,665 9.4%

Dauphin $ 707,287 26,128 6,851 1,848 34,827 16.4%

Franklin $ 142,623 4,204 - 2,250 6,454 12.3%

Fulton $ 106,868 1,870 - 1,523 3,393 11.7%

Huntingdon $ 176,860 4,518 - 6,269 10,787 8.3%

Lancaster $ 541,084 20,730 618 5,845 27,193 7.6%

Lebanon $ 340,733 17,127 194 1,676 18,997 7.8%

Lehigh $ 689,230 25,696 - 15,282 40,978 3.0%

Northampton $ 512,912 17,717 - 17,911 35,628 2.6%

Perry $ 85,161 2,158 - 1,507 3,665 11.5%

York/Adams $ 302,631 8,896 914 5,496 15,306 8.7%

HC-L/C Zone $ 4,262,133 155,949 21,569 67,313 244,831 9.1%

40

MATP 4Q FY 14/15

Northwest

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Cameron $ 25,082 446 10 279 735 9.7%

Clarion $ 146,480 2,913 - 1,996 4,909 10.2%

Clearfield $ 243,626 7,142 - 7,158 14,300 8.4%

Crawford $ 312,825 4,943 1,503 15,848 22,294 7.4%

Elk $ 88,858 2,822 2 984 3,808 8.2%

Erie $ 547,811 23,337 - 4,461 27,798 5.7%

Forest $ 18,160 528 - 277 805 6.8%

Jefferson $ 598,081 17,921 - 5,774 23,695 6.2%

McKean $ 120,806 2,249 41 647 2,937 14.5%

Mercer $ 185,658 8,571 10 3,480 12,061 9.5%

Potter $ 55,579 1,471 - 1,672 3,143 14.3%

Venango $ 287,933 5,666 425 1,659 7,750 15.0%

Warren $ 73,896 1,694 96 2,441 4,231 15.5%

HC-Northwest Zone $ 2,704,795 79,703 2,087 46,676 128,466 10.1%

41

MATP 4Q FY 14/15

Northeast

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Bradford/Tioga $ 248,886 6,172 167 1,706 8,045 10.1%

Carbon $ 273,190 6,761 - 2,582 9,343 5.5%

Centre $ 101,220 4,683 - 2,098 6,781 10.5%

Clinton $ 155,706 3,095 - 512 3,607 13.0%

Columbia $ 137,901 4,955 - 3,851 8,806 8.0%

Juniata $ 32,692 925 - 458 1,383 8.2%

Lackawanna $ 222,686 7,803 3,149 5,982 16,934 4.9%

Luzerne $ 293,461 14,914 1,148 7,682 23,744 13.7%

Lycoming $ 446,639 10,619 1,952 4,259 16,830 10.5%

Mifflin $ 94,115 4,346 - 1,249 5,595 10.7%

Monroe $ 198,370 5,930 1,401 4,170 11,501 9.1%

Montour $ 48,969 1,774 - 788 2,562 9.7%

Northumberland $ 151,404 8,062 - 3,227 11,289 9.1%

Pike $ 60,518 1,355 - 2,098 3,453 7.1%

Schuylkill $ 213,598 4,610 1,165 2,948 8,723 10.5%

Snyder $ 69,818 2,274 - 790 3,064 11.7%

Sullivan $ 19,607 347 37 120 504 7.3%

Susquehanna $ 121,062 2,376 - 1,364 3,740 10.8%

Union $ 44,323 1,554 - 603 2,157 15.3%

Wayne $ 124,885 3,625 - 1,592 5,217 11.8%

Wyoming $ 34,816 775 - 490 1,265 9.7%

HC-Northeast Zone $ 3,093,866 96,955 9,019 48,569 154,543 9.9%

42

Useful Information

To view a complete Pennsylvania Medicaid Managed Care Organization Directory use this link, http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/manage dcareinformation/index.htm, and choose the most current Directory.

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