BMCO Monthly Physical Health Managed Care Program ...€¦ · HC NE – 2013 4 . Mandatory...

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: April 24, 2019

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 ENROLLMENT BY PLAN AND BY COUNTY March 2019

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

09 Bucks 5,682 7,096 12,199 40,167 65,144

15 Chester 12,848 7,269 2,710 22,208 45,035

23 Delaware 8,504 9,775 8,459 68,533 95,271

46 Montgomery 9,300 10,852 10,703 55,879 86,734

51 Philadelphia 53,410 34,843 204,242 242,092 534,587

TOTAL 89,744 69,835 238,313 428,879 826,771

PERCENTAGE 11% 8% 29% 52%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

02 Allegheny 56,613 20,510 101,360 8,175 186,658

03 Armstrong 960 523 9,668 423 11,574

04 Beaver 10,544 2,294 13,109 1,268 27,215

05 Bedford 621 1,023 5,888 626 8,158

07 Blair 5,623 3,469 14,017 1,968 25,077

10 Butler 4,890 1,154 14,459 841 21,344

11 Cambria 3,526 4,898 15,026 2,648 26,098

26 Fayette 3,610 8,509 19,427 784 32,330

30 Greene 735 3,029 3,334 355 7,453

32 Indiana 2,279 1,610 8,684 590 13,163

37 Lawrence 6,512 1,499 8,725 743 17,479

56 Somerset 1,607 2,649 6,468 984 11,708

63 Washington 5,294 5,092 18,658 1,479 30,523

65 Westmoreland 10,608 7,420 31,479 1,983 51,490

TOTAL 113,422 63,679 270,302 22,867 470,270

PERCENTAGE 24% 14% 57% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 4/05/19

5


cont. LEHIGH/CAPITAL

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

01 Adams 3,985 4,470 1,283 1,262 1,429 12,429

06 Berks 14,447 8,104 6,862 8,775 41,362 79,550

21 Cumberland 11,512 3,704 4,030 2,258 4,901 26,405

22 Dauphin 26,793 10,450 8,038 5,604 6,588 57,473

28 Franklin 1,014 1,123 7,912 424 11,933 22,406

29 Fulton 150 294 790 519 676 2,429

31 Huntingdon 421 572 1,024 3,404 1,564 6,985

36 Lancaster 21,544 10,446 3,265 9,707 29,227 74,189

38 Lebanon 13,520 1,791 1,798 1,969 3,338 22,416

39 Lehigh 21,090 5,238 2,307 5,383 38,482 72,500

48 Northampton 12,060 2,814 2,064 2,643 24,284 43,865

50 Perry 3,381 677 733 427 1,053 6,271

67 York 20,447 20,910 7,696 7,307 14,615 70,975

TOTAL 150,364 70,593 47,802 49,682 179,452 497,893

PERCENTAGE 30% 14% 10% 10% 36%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

12 Cameron 805 27 105 40 977

16 Clarion 4,122 688 535 591 5,936

17 Clearfield 9,887 1,287 1,976 1,726 14,876

20 Crawford 11,853 909 1,018 1,087 14,867

24 Elk 3,446 371 278 278 4,373

25 Erie 32,380 13,209 5,718 9,676 60,983

27 Forest 565 86 75 45 771

33 Jefferson 6,406 785 334 348 7,873

42 McKean 6,173 232 1,193 627 8,225

43 Mercer 13,870 3,548 2,133 2,051 21,602

53 Potter 1,702 31 1,216 59 3,008

61 Venango 6,940 742 962 914 9,558

62 Warren 4,620 646 714 447 6,427

TOTAL 102,769 22,561 16,257 17,889 159,476

PERCENTAGE 64% 14% 10% 11%


6


cont.

NORTHEAST

County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 2,995 4,371 3,280 10,646

13 Carbon 7,674 2,478 933 11,085

14 Centre 2,445 5,906 2,474 10,825

18 Clinton 1,135 4,958 770 6,863

19 Columbia 1,531 6,913 1,161 9,605

34 Juniata 804 1,725 655 3,184

35 Lackawanna 7,693 30,641 5,686 44,020

40 Luzerne 18,414 44,568 8,466 71,448

41 Lycoming 5,070 14,565 1,502 21,137

44 Mifflin 2,069 4,372 1,583 8,024

45 Monroe 15,211 11,489 5,016 31,716

47 Montour 336 1,520 288 2,144

49 Northumberland 3,277 10,488 3,507 17,272

52 Pike 2,845 5,126 1,336 9,307

54 Schuylkill 8,954 13,963 2,953 25,870

55 Snyder 1,140 2,996 829 4,965

57 Sullivan 129 439 141 709

58 Susquehanna 1,197 4,437 926 6,560

59 Tioga 5,764 924 543 7,231

60 Union 857 2,582 692 4,131

64 Wayne 1,689 5,501 1,162 8,352

66 Wyoming 765 3,280 543 4,588

TOTAL 91,994 183,242 44,446 319,682

PERCENTAGE 29% 59% 14%


7

Mandatory MARKET SHARE BY PLAN – STATEWIDE March 2019

Total Enrollment = 2,274,092

AmeriHealth NE 91,994

4% Aetna

202,839 9%

AmeriHealth 195,709

9%

Gateway 286,347

13%

Health Partners 238,313

10%

Keystone 428,879

19%

United 224,016

10%

UPMC 422,753

18%

Geisinger 183,242

8%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 4/05/19 8

Mandatory MARKET SHARE BY ZONE AND BY PLAN March 2019

Southeast

Aetna 69,835

8%

Health Partners 238,313

29%

Keystone428,879

52%

United 89,744

11%

Southwest Aetna 22,867

5%

United 63,679

14%

UPMC 270,302

57%

Gateway 113,422

24% Lehigh/Capital

Gateway 150,364

30%

Ameri-Health

179,452 36%

UPMC 49,682

10%

United 70,593

14%

Aetna 47,802

10%

Northwest

Aetna 17,889

11%

Gateway 22,561

14%

UPMC 102,769

65%

Ameri-Health 16,257

10%

Northeast

Aetna 44,446

14%

Ameri-Health NE

91,994 29%

Geisinger 183,242

57%


9

Mandatory ENROLLMENT BY PLAN, BY RACE AND BY COUNTY March 2019

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

Black or African American

42 United 634 2,421 4,394 2,141 33,073 42,663

43 Aetna 661 1,202 4,316 2,263 21,037 29,479

45 Health Partners 1,382 469 4,483 3,042 97,032 106,408

47 Keystone 4,218 3,778 32,969 12,849 146,258 200,072

Southeast MCOs 6,895 7,870 46,162 20,295 297,400 378,622

American Indian or Alaskan

Native

42 United 8 34 20 36 72 170

43 Aetna 24 38 15 42 84 203

45 Health Partners 39 10 16 42 239 346

47 Keystone 87 92 122 179 336 816

Southeast MCOs 158 174 173 299 731 1,535

Asian

42 United 267 293 479 472 3,441 4,952

43 Aetna 289 197 484 787 1,474 3,231

45 Health Partners 723 73 433 738 7,948 9,915

47 Keystone 1,354 645 4,465 3,818 19,284 29,566

Southeast MCOs 2,633 1,208 5,861 5,815 32,147 47,664

White

42 United 3,774 7,101 2,629 4,683 7,995 26,182

43 Aetna 5,009 4,511 3,938 6,015 6,532 26,005

45 Health Partners 7,672 1,598 2,383 4,951 33,110 49,714

47 Keystone 28,329 13,543 24,465 28,936 39,743 135,016

Southeast MCOs 44,784 26,753 33,415 44,585 87,380 236,917

Other or system default

42 United 647 2,109 618 1,361 6,801 11,536

43 Aetna 650 840 622 1,098 4,295 7,505

45 Health Partners 1,705 370 797 1,351 60,092 64,315

47 Keystone 4,421 3,013 4,617 7,495 29,507 49,053

Southeast MCOs 7,423 6,332 6,654 11,305 100,695 132,409

Native Hawaiian or Other

Pacific Islander

42 United 16 20 12 25 111 184

43 Aetna 28 14 15 28 76 161

45 Health Partners 28 14 14 19 307 382

47 Keystone 74 33 61 90 191 449

Southeast MCOs 146 81 102 162 685 1,176

Unknown

42 United 336 870 352 582 1,917 4,057

43 Aetna 435 467 385 619 1,345 3,251

45 Health Partners 650 176 333 560 5,514 7,233

47 Keystone 1,684 1,104 1,834 2,512 6,773 13,907

Southeast MCOs 3,105 2,617 2,904 4,273 15,549 28,448

MCO TOTAL

42 United 64,648 44,947 95,122 86,456 534,828 89,744

43 Aetna 7,096 7,269 9,775 10,852 34,843 69,835

45 Health Partners 12,199 2,710 8,459 10,703 204,242 238,313

47 Keystone 40,167 22,208 68,533 55,879 242,092 428,879

TOTAL 65,144 45,035 95,271 86,734 534,587 826,771

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 4/05/19

10


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

Black or African

American

31 Gateway 27,467 23 2,518 12 395 224 525 341

32 United 8,274 16 460 9 242 36 970 812

34 UPMC 33,065 156 2,129 61 715 412 1,428 1,531

59 Aetna 2,939 5 256 7 124 19 743 84

Southwest MCOs 71,745 200 5,363 89 1,476 691 3,666 2,768

American Indian or

Alaskan Native

31 Gateway 132 1 17 1 5 4 12 7

32 United 47 0 5 1 11 1 3 11

34 UPMC 319 16 41 11 21 33 28 47

59 Aetna 20 0 10 0 4 1 4 4

Southwest MCOs 518 17 73 13 41 39 47 69

Asian

31 Gateway 706 1 33 0 7 21 5 12

32 United 478 2 27 3 24 20 12 13

34 UPMC 4,845 25 108 23 92 163 33 63

59 Aetna 180 0 9 3 7 10 9 3

Southwest MCOs 6,209 28 177 29 130 214 59 91

White

31 Gateway 24,936 919 7,718 598 5,124 4,501 2,876 3,172

32 United 10,020 486 1,667 991 3,122 998 3,753 7,492

34 UPMC 54,166 9,338 10,223 5,665 12,863 13,156 13,062 17,287

59 Aetna 4,020 408 917 604 1,785 749 1,794 654

Southwest MCOs 93,142 11,151 20,525 7,858 22,894 19,404 21,485 28,605

Other or system

default

31 Gateway 1,798 3 182 7 48 71 62 35

32 United 852 12 76 10 34 47 99 98

34 UPMC 4,783 66 357 89 169 341 279 220

59 Aetna 488 2 53 9 23 34 59 19

Southwest MCOs 7,921 83 668 115 274 493 499 372

Native Hawaiian or

Other Pacific Islander

31 Gateway 35 0 5 0 2 3 1 3

32 United 20 0 0 0 0 0 4 8

34 UPMC 140 2 11 3 1 6 9 17

59 Aetna 24 0 0 0 0 0 3 1

Southwest MCOs 219 2 16 3 3 9 17 29

Unknown

31 Gateway 1,539 13 71 3 42 66 45 40

32 United 819 7 59 9 36 52 57 75

34 UPMC 4,042 65 240 36 156 348 187 262

59 Aetna 504 8 23 3 25 28 36 19

Southwest MCOs 6,904 93 393 51 259 494 325 396

MCO TOTAL

31 Gateway 186,906 11,540 27,310 8,144 25,053 21,439 26,077 3,610

32 United 20,510 523 2,294 1,023 3,469 1,154 4,898 8,509

34 UPMC 101,360 9,668 13,109 5,888 14,017 14,459 15,026 19,427

59 Aetna 8,175 423 1,268 626 1,968 841 2,648 784

TOTAL 186,658 11,574 27,215 8,158 25,077 21,344 26,098 32,330


11


Southwest cont.

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

Black or African

American

31 Gateway 22 81 916 16 674 1,469 34,683

32 United 31 77 217 23 586 734 12,487

34 UPMC 43 236 884 73 1,677 2,206 44,616

59 Aetna 9 36 118 20 177 172 4,709

Southwest MCOs 105 430 2,135 132 3,114 4,581 96,495

American Indian or

Alaskan Native

31 Gateway 0 3 8 1 9 24 224

32 United 2 3 0 3 12 19 118

34 UPMC 13 22 12 5 24 56 648

59 Aetna 0 1 2 4 4 9 63

Southwest MCOs 15 29 22 13 49 108 1,053

Asian

31 Gateway 1 21 9 5 15 36 872

32 United 2 5 7 4 21 31 649

34 UPMC 14 50 45 27 136 247 5,871

59 Aetna 3 5 2 2 9 19 261

Southwest MCOs 20 81 63 38 181 333 7,653

White

31 Gateway 696 2,114 5,475 1,552 4,398 8,706 72,785

32 United 2,968 1,473 1,214 2,562 4,287 6,279 47,312

34 UPMC 3,199 8,124 7,544 6,211 15,957 27,420 204,215

59 Aetna 334 513 591 922 1,199 1,610 16,100

Southwest MCOs 7,197 12,224 14,824 11,247 25,841 44,015 340,412

Other or system

default

31 Gateway 13 30 57 23 90 181 2,600

32 United 20 22 43 33 94 156 1,596

34 UPMC 38 102 136 70 391 663 7,704

59 Aetna 5 20 19 13 31 74 849

Southwest MCOs 76 174 255 139 606 1,074 12,749

Native Hawaiian or


31 Gateway 0 3 0 1 0 2 55

32 United 0 0 0 0 1 3 36

34 UPMC 2 1 2 0 9 19 222

59 Aetna 0 0 0 0 2 0 30

Southwest MCOs 2 4 2 1 12 24 343

Unknown

31 Gateway 3 27 47 9 108 190 2,203

32 United 6 30 18 24 91 198 1,481

34 UPMC 25 149 102 82 464 868 7,026

59 Aetna 4 15 11 23 57 99 855

Southwest MCOs 38 221 178 138 720 1,355 11,565

MCO TOTAL

31 Gateway 7,480 13,174 17,452 11,681 30,569 51,346 113,422

32 United 3,029 1,610 1,499 2,649 5,092 7,420 63,679

34 UPMC 3,334 8,684 8,725 6,468 18,658 31,479 270,302

59 Aetna 355 590 743 984 1,479 1,983 22,867

TOTAL 7,453 13,163 17,479 11,708 30,523 51,490 470,270


12


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


51 Gateway 139 1,320 1,461 10,496 78 5 13

52 United 264 693 504 3,807 115 4 35

53 Aetna 54 837 414 2,547 653 19 46

54 UPMC 52 667 238 1,591 36 14 93

57 AmeriHealth 52 3,412 514 1,929 1,017 18 35

Lehigh/Capital MCOs 561 6,929 3,131 20,370 1,899 60 222

American Indian or

Alaskan Native

51 Gateway 10 25 37 69 6 1 1

52 United 6 14 11 29 3 0 0

53 Aetna 5 16 14 34 13 2 0

54 UPMC 4 13 7 15 7 1 0

57 AmeriHealth 1 51 7 31 49 4 1

Lehigh/Capital MCOs 26 119 76 178 78 8 2

Asian

51 Gateway 31 153 312 1,369 13 0 2

52 United 35 102 173 661 2 0 2

53 Aetna 12 109 114 447 44 1 4

54 UPMC 15 126 73 384 2 0 15

57 AmeriHealth 9 304 124 246 99 0 2

Lehigh/Capital MCOs 102 794 796 3,107 160 1 25

White

51 Gateway 3,441 6,814 7,879 8,268 772 141 393

52 United 3,464 4,326 2,291 3,580 837 279 525

53 Aetna 1,038 3,906 2,809 3,379 6,144 748 954

54 UPMC 1,035 5,332 1,512 2,374 327 503 3,228

57 AmeriHealth 1,176 14,338 3,447 2,563 8,610 625 1,494

Lehigh/Capital MCOs 10,154 34,716 17,938 20,164 16,690 2,296 6,594


51 Gateway 195 5,608 1,285 5,378 81 0 8

52 United 520 2,548 502 1,692 108 9 5

53 Aetna 106 1,646 385 1,127 603 13 14

54 UPMC 97 2,140 287 826 33 0 43

57 AmeriHealth 111 21,551 536 1,258 1,352 20 18

Lehigh/Capital MCOs 1,029 33,493 2,995 10,281 2,177 42 88


Pacific Islander

51 Gateway 2 11 17 22 1 0 0

52 United 10 30 8 18 1 0 0

53 Aetna 2 18 8 21 13 0 0

54 UPMC 3 24 9 24 0 0 1

57 AmeriHealth 5 78 8 12 19 0 1


Unknown

51 Gateway 167 516 521 1,191 63 3 4

52 United 171 391 215 663 57 2 5

53 Aetna 66 330 286 483 442 7 6

54 UPMC 56 473 132 390 19 1 24

57 AmeriHealth 75 1,628 265 549 787 9 13

Lehigh/Capital MCOs 535 3,338 1,419 3,276 1,368 22 52

MCO TOTAL

51 Gateway 12,258 79,489 26,341 57,326 22,383 2,403 421

52 United 4,470 8,104 3,704 10,450 1,123 294 572

53 Aetna 1,283 6,862 4,030 8,038 7,912 790 1,024

54 UPMC 1,262 8,775 2,258 5,604 424 519 3,404

57 AmeriHealth 1,429 41,362 4,901 6,588 11,933 676 1,564

TOTAL 12,429 79,550 26,405 57,473 22,406 2,429 6,985

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 1,798 581 2,941 1,730 52 2,313 22,927

52 United 1,299 116 807 416 11 3,787 11,858

53 Aetna 346 74 372 308 28 1,218 6,916

54 UPMC 1,005 118 762 277 15 984 5,852

57 AmeriHealth 3,271 152 4,559 2,687 19 2,197 19,862

Lehigh/Capital MCOs 7,719 1,041 9,441 5,418 125 10,499 67,415

American Indian or

Alaskan Native

51 Gateway 48 12 29 27 3 75 343

52 United 25 7 6 5 1 45 152

53 Aetna 11 9 7 11 6 57 185

54 UPMC 28 4 13 7 1 47 147

57 AmeriHealth 63 5 58 83 1 61 415

Lehigh/Capital MCOs 175 37 113 133 12 285 1,242

Asian

51 Gateway 806 110 326 210 7 212 3,551

52 United 293 23 135 66 3 245 1,740

53 Aetna 92 23 57 37 4 106 1,050

54 UPMC 355 26 165 57 0 73 1,291

57 AmeriHealth 669 72 650 509 1 160 2,845

Lehigh/Capital MCOs 2,215 254 1,333 879 15 796 10,477

White

51 Gateway 13,470 8,979 14,326 7,042 3,204 14,568 89,297

52 United 5,677 1,180 3,355 1,746 610 11,627 39,497

53 Aetna 2,109 1,231 1,429 1,324 654 4,934 30,659

54 UPMC 5,826 1,356 3,529 1,776 379 4,723 31,900

57 AmeriHealth 14,823 1,736 26,841 15,430 979 8,436 100,498



51 Gateway 3,986 3,402 2,746 2,610 69 2,538 27,906

52 United 2,448 368 612 404 29 4,335 13,580

53 Aetna 498 382 314 267 25 976 6,356

54 UPMC 1,607 364 604 368 21 1,005 7,395

57 AmeriHealth 8,262 1,186 4,904 4,589 34 2,905 46,726


Native Hawaiian or


51 Gateway 28 9 45 19 0 32 186

52 United 21 1 25 11 0 27 152

53 Aetna 3 5 3 14 0 11 98

54 UPMC 13 3 29 11 0 15 132

57 AmeriHealth 53 17 81 61 1 46 382


Unknown

51 Gateway 1,408 427 677 422 46 709 6,154

52 United 683 96 298 166 23 844 3,614

53 Aetna 206 74 125 103 16 394 2,538

54 UPMC 873 98 281 147 11 460 2,965

57 AmeriHealth 2,086 170 1,389 925 18 810 8,724

Lehigh/Capital MCOs 5,256 865 2,770 1,763 114 3,217 23,995

MCO TOTAL

51 Gateway 73,803 22,374 72,385 43,771 6,196 70,776 150,364

52 United 10,446 1,791 5,238 2,814 677 20,910 70,593

53 Aetna 3,265 1,798 2,307 2,064 733 7,696 47,802

54 UPMC 9,707 1,969 5,383 2,643 427 7,307 49,682

57 AmeriHealth 29,227 3,338 38,482 24,284 1,053 14,615 179,452

TOTAL 74,189 22,416 72,500 43,865 6,271 70,975 497,893

Racial/Ethnic

information is self-

reported by consumers.



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


35 UPMC 18 122 114 411 53 4,971 6

36 Gateway 0 13 24 42 7 3,391 0

37 AmeriHealth 7 27 28 37 3 1,249 2

56 Aetna 0 29 24 31 3 2,539 0

Northwest MCOs 25 191 190 521 66 12,150 8


Native

35 UPMC 2 3 17 33 15 99 2

36 Gateway 0 1 0 1 0 30 4

37 AmeriHealth 0 3 2 0 1 14 0

56 Aetna 0 0 1 1 0 31 0

Northwest MCOs 2 7 20 35 16 174 6

Asian

35 UPMC 7 14 45 37 9 1,340 1

36 Gateway 0 2 1 0 2 197 0

37 AmeriHealth 0 0 7 2 0 146 0

56 Aetna 0 2 4 0 4 116 0

Northwest MCOs 7 18 57 39 15 1,799 1

White

35 UPMC 769 3,870 9,561 11,105 3,330 23,655 549

36 Gateway 26 663 1,240 849 359 8,558 81

37 AmeriHealth 98 496 1,892 962 270 3,924 73

56 Aetna 40 549 1,669 1,027 266 6,315 41

Northwest MCOs 933 5,578 14,362 13,943 4,225 42,452 744


35 UPMC 8 42 64 120 20 1,765 4

36 Gateway 1 6 13 6 3 854 1

37 AmeriHealth 0 3 22 11 3 294 0

56 Aetna 0 5 12 13 3 525 3

Northwest MCOs 9 56 111 150 29 3,438 8


Pacific Islander

35 UPMC 1 5 5 5 0 29 0

36 Gateway 0 0 0 0 0 12 0

37 AmeriHealth 0 0 1 0 1 8 0

56 Aetna 0 1 0 0 1 10 0

Northwest MCOs 1 6 6 5 2 59 0

Unknown

35 UPMC 0 66 81 142 19 521 3

36 Gateway 0 3 9 11 0 167 0

37 AmeriHealth 0 6 24 6 0 83 0

56 Aetna 0 5 16 15 1 140 1

Northwest MCOs 0 80 130 174 20 911 4

MCO TOTAL

35 UPMC 998 5,997 14,899 14,894 4,317 60,936 771

36 Gateway 27 688 1,287 909 371 13,209 86

37 AmeriHealth 105 535 1,976 1,018 278 5,718 75

56 Aetna 40 591 1,726 1,087 278 9,676 45

TOTAL 977 5,936 14,876 14,867 4,373 60,983 771


15


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


35 UPMC 56 76 1,721 12 192 39 7,791

36 Gateway 6 3 653 0 31 15 4,185

37 AmeriHealth 4 17 445 16 25 7 1,867

56 Aetna 6 10 412 0 32 1 3,087

Northwest MCOs 72 106 3,231 28 280 62 16,930


Native

35 UPMC 13 19 22 2 18 14 259

36 Gateway 2 1 3 0 3 2 47

37 AmeriHealth 1 1 8 4 0 2 36

56 Aetna 0 7 1 0 4 2 47

Northwest MCOs 16 28 34 6 25 20 389

Asian

35 UPMC 18 24 95 1 23 9 1,623

36 Gateway 1 0 19 0 2 0 224

37 AmeriHealth 3 9 11 2 4 2 186

56 Aetna 1 1 10 0 2 1 141

Northwest MCOs 23 34 135 3 31 12 2,174

White

35 UPMC 6,255 5,984 11,600 1,663 6,577 4,502 89,420

36 Gateway 774 225 2,782 31 687 622 16,897

37 AmeriHealth 319 1,156 1,597 1,172 920 692 13,571

56 Aetna 336 606 1,536 58 853 433 13,729

Northwest MCOs 7,684 7,971 17,515 2,924 9,037 6,249 133,617


35 UPMC 30 46 222 9 71 35 2,436

36 Gateway 0 3 44 0 11 5 947

37 AmeriHealth 2 8 34 12 4 7 400

56 Aetna 2 2 41 0 12 8 626

Northwest MCOs 34 59 341 21 98 55 4,409


Pacific Islander

35 UPMC 1 2 7 0 3 4 62

36 Gateway 0 0 0 0 0 0 12

37 AmeriHealth 0 0 1 0 2 1 14

56 Aetna 0 0 1 0 2 0 15


Unknown

35 UPMC 33 22 203 15 56 17 1,178

36 Gateway 2 0 47 0 8 2 249

37 AmeriHealth 5 2 37 10 7 3 183

56 Aetna 3 1 50 1 9 2 244

Northwest MCOs 43 25 337 26 80 24 1,854

MCO TOTAL

35 UPMC 7,829 8,229 21,673 3,036 9,558 6,444 102,769

36 Gateway 785 232 3,548 31 742 646 22,561

37 AmeriHealth 334 1,193 2,133 1,216 962 714 16,257

56 Aetna 348 627 2,051 59 914 447 17,889

TOTAL 7,873 8,225 21,602 3,008 9,558 6,427 159,476


16


Northeast

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


41 AmeriHealth NE 46 276 117 38 68 9 883 2,073

44 Geisinger 70 99 253 104 225 22 2,658 4,560

50 Aetna 49 57 146 31 77 13 773 1,327

Northeast MCOs 165 432 516 173 370 44 4,314 7,960

American Indian or

Alaskan Native

41 AmeriHealth NE 12 20 8 3 2 1 25 30

44 Geisinger 6 9 14 2 9 2 75 67

50 Aetna 5 4 8 0 2 1 28 10

Northeast MCOs 23 33 30 5 13 4 128 107

Asian

41 AmeriHealth NE 27 18 70 8 13 1 216 120

44 Geisinger 15 16 152 13 43 9 920 403

50 Aetna 7 5 84 2 10 4 180 88

Northeast MCOs 49 39 306 23 66 14 1,316 611

White

41 AmeriHealth NE 2,816 6,878 2,080 1,058 1,352 692 5,152 10,130

44 Geisinger 4,180 2,181 5,239 4,724 6,379 1,525 22,025 30,212

50 Aetna 3,129 778 2,100 714 998 577 3,738 5,544

Northeast MCOs 10,125 9,837 9,419 6,496 8,729 2,794 30,915 45,886


41 AmeriHealth NE 41 318 92 12 68 81 1,056 5,622

44 Geisinger 42 121 127 63 170 137 3,761 8,277

50 Aetna 26 62 74 11 44 57 679 1,260

Northeast MCOs 109 501 293 86 282 275 5,496 15,159


Pacific Islander

41 AmeriHealth NE 2 5 4 2 2 0 12 34

44 Geisinger 2 0 8 1 4 0 30 69

50 Aetna 1 1 7 0 5 0 10 22

Northeast MCOs 5 6 19 3 11 0 52 125

Unknown

41 AmeriHealth NE 51 159 74 14 26 20 349 405

44 Geisinger 56 52 113 51 83 30 1,172 980

50 Aetna 63 26 55 12 25 3 278 215

Northeast MCOs 170 237 242 77 134 53 1,799 1,600

MCO TOTAL

41 AmeriHealth NE 10,712 11,073 10,770 6,865 9,565 3,188 44,011 18,414

44 Geisinger 4,371 2,478 5,906 4,958 6,913 1,725 30,641 44,568

50 Aetna 3,280 933 2,474 770 1,161 655 5,686 8,466

TOTAL 10,646 11,085 10,825 6,863 9,605 3,184 44,020 71,448

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 943 46 2,708 15 238 389 401 35

44 Geisinger 2,106 110 2,117 40 444 316 538 93

50 Aetna 221 51 1,146 8 235 120 192 24

Northeast MCOs 3,270 207 5,971 63 917 825 1,131 152

American Indian or

Alaskan Native

41 AmeriHealth NE 11 5 49 1 7 14 22 2

44 Geisinger 22 5 36 4 20 30 20 5

50 Aetna 2 1 22 0 7 6 14 3

Northeast MCOs 35 11 107 5 34 50 56 10

Asian

41 AmeriHealth NE 20 5 168 5 13 30 43 20

44 Geisinger 61 17 177 20 47 52 67 4

50 Aetna 7 8 61 6 9 10 21 11

Northeast MCOs 88 30 406 31 69 92 131 35

White

41 AmeriHealth NE 3,956 1,970 9,073 297 2,760 1,970 7,657 1,046

44 Geisinger 12,024 4,156 6,726 1,399 9,345 4,188 12,443 2,795

50 Aetna 1,207 1,479 2,548 257 3,044 982 2,543 761

Northeast MCOs 17,187 7,605 18,347 1,953 15,149 7,140 22,643 4,602


41 AmeriHealth NE 92 26 2,432 15 194 329 664 21

44 Geisinger 221 57 1,855 43 462 371 683 69

50 Aetna 39 35 919 11 157 151 134 19

Northeast MCOs 352 118 5,206 69 813 851 1,481 109


Pacific Islander

41 AmeriHealth NE 6 0 58 0 5 12 9 0

44 Geisinger 7 3 32 2 8 10 10 0

50 Aetna 4 2 21 1 1 5 0 1

Northeast MCOs 17 5 111 3 14 27 19 1

Unknown

41 AmeriHealth NE 42 17 723 3 60 101 158 16

44 Geisinger 124 24 546 12 162 159 202 30

50 Aetna 22 7 299 5 54 62 49 10

Northeast MCOs 188 48 1,568 20 276 322 409 56

MCO TOTAL

41 AmeriHealth NE 21,157 8,056 31,808 2,177 17,262 9,238 25,886 1,140

44 Geisinger 14,565 4,372 11,489 1,520 10,488 5,126 13,963 2,996

50 Aetna 1,502 1,583 5,016 288 3,507 1,336 2,953 829

TOTAL 21,137 8,024 31,716 2,144 17,272 9,307 25,870 4,965



18


Northeast cont.

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


41 AmeriHealth NE 1 10 87 53 52 8 8,496

44 Geisinger 4 32 20 177 146 30 14,164

50 Aetna 9 20 13 54 33 9 4,608

Northeast MCOs 14 62 120 284 231 47 27,268

American Indian or

Alaskan Native

41 AmeriHealth NE 2 5 15 0 14 8 256

44 Geisinger 0 10 1 4 20 10 371

50 Aetna 1 1 2 2 6 5 130

Northeast MCOs 3 16 18 6 40 23 757

Asian

41 AmeriHealth NE 0 3 17 3 18 2 820

44 Geisinger 1 14 5 17 28 17 2,098

50 Aetna 0 1 1 1 5 1 522

Northeast MCOs 1 18 23 21 51 20 3,440

White

41 AmeriHealth NE 119 1,151 5,551 763 1,522 717 68,710

44 Geisinger 430 4,290 872 2,247 5,134 3,134 145,648

50 Aetna 129 886 505 615 1,058 515 34,107

Northeast MCOs 678 6,327 6,928 3,625 7,714 4,366 248,465


41 AmeriHealth NE 3 17 65 29 47 13 11,237

44 Geisinger 2 30 12 110 99 38 16,750

50 Aetna 1 9 15 17 35 6 3,761

Northeast MCOs 6 56 92 156 181 57 31,748


Pacific Islander

41 AmeriHealth NE 0 0 2 0 2 0 155

44 Geisinger 0 1 0 0 3 0 190

50 Aetna 0 0 0 0 7 0 88

Northeast MCOs 0 1 2 0 12 0 433

Unknown

41 AmeriHealth NE 4 11 27 9 34 17 2,320

44 Geisinger 2 60 14 27 71 51 4,021

50 Aetna 1 9 7 3 18 7 1,230

Northeast MCOs 7 80 48 39 123 75 7,571

MCO TOTAL

41 AmeriHealth NE 725 6,551 7,234 4,167 8,373 4,605 91,994

44 Geisinger 439 4,437 924 2,582 5,501 3,280 183,242

50 Aetna 141 926 543 692 1,162 543 44,446

TOTAL 709 6,560 7,231 4,131 8,352 4,588 319,682



19

Mandatory ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY March 2019

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 12 11 6 22 64 115

43 Aetna 13 7 7 19 40 86

45 Health Partners 11 11 12 20 84 138

47 Keystone 26 14 31 54 127 252

Southeast MCOs 62 43 56 115 315 591

Non-Hispanic

42 United 5,027 9,603 7,982 7,996 46,763 77,371

43 Aetna 6,484 6,084 9,256 9,925 30,606 62,355

45 Health Partners 10,482 2,398 7,735 9,523 139,415 169,553

47 Keystone 35,673 17,898 64,486 49,151 213,769 380,977

Southeast MCOs 57,666 35,983 89,459 76,595 430,553 690,256

Hispanic

42 United 643 3,234 516 1,282 6,583 12,258

43 Aetna 599 1,178 512 908 4,197 7,394

45 Health Partners 1,706 301 712 1,160 64,743 68,622

47 Keystone 4,468 4,296 4,016 6,674 28,196 47,650

Southeast MCOs 7,416 9,009 5,756 10,024 103,719 135,924

TOTAL 65,144 45,035 95,271 86,734 534,587 826,771



20


Southwest

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

Other/Unknown

31 Gateway 34 0 2 0 2 5 1 0

32 United 15 1 2 0 1 1 2 2

34 UPMC 81 2 8 1 5 9 3 11

59 Aetna 16 0 1 1 0 0 1 0

Southwest MCOs 146 3 13 2 8 15 7 13

Non-Hispanic

31 Gateway 55,739 945 10,409 617 5,546 4,802 3,451 3,583

32 United 20,023 510 2,223 1,015 3,418 1,124 4,791 8,442

34 UPMC 98,743 9,583 12,896 5,828 13,825 14,160 14,837 19,205

59 Aetna 7,962 417 1,234 621 1,938 817 2,589 756

Southwest MCOs 182,467 11,455 26,762 8,081 24,727 20,903 25,668 31,986

Hispanic

31 Gateway 840 15 133 4 75 83 74 27

32 United 472 12 69 8 50 29 105 65

34 UPMC 2,536 83 205 59 187 290 186 211

59 Aetna 197 6 33 4 30 24 58 28

Southwest MCOs 4,045 116 440 75 342 426 423 331

TOTAL 186,658 11,574 27,215 8,158 25,077 21,344 26,098 32,330



21


Southwest cont.

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

Other/Unknown

31 Gateway 0 0 0 1 7 4 56

32 United 1 1 0 0 2 14 42

34 UPMC 2 3 2 4 6 20 157

59 Aetna 0 1 0 0 4 2 26

Southwest MCOs 3 5 2 5 19 40 281

Non-Hispanic

31 Gateway 727 2,258 6,459 1,589 5,202 10,498 111,825

32 United 3,013 1,580 1,457 2,610 5,019 7,286 62,511

34 UPMC 3,299 8,585 8,519 6,400 18,339 31,054 265,273

59 Aetna 353 568 725 971 1,435 1,941 22,327

Southwest MCOs 7,392 12,991 17,160 11,570 29,995 50,779 461,936

Hispanic

31 Gateway 8 21 53 17 85 106 1,541

32 United 15 29 42 39 71 120 1,126

34 UPMC 33 96 204 64 313 405 4,872

59 Aetna 2 21 18 13 40 40 514

Southwest MCOs 58 167 317 133 509 671 8,053

TOTAL 7,453 13,163 17,479 11,708 30,523 51,490 470,270



22


Lehigh/Capital

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

Other/Unknown

51 Gateway 2 10 7 8 1 0 0

52 United 3 7 5 17 0 0 0

53 Aetna 2 5 0 6 4 0 0

54 UPMC 0 8 1 3 2 1 0

57 AmeriHealth 1 13 4 6 8 0 0


Non-Hispanic

51 Gateway 3,710 7,755 10,626 20,853 934 146 413

52 United 3,643 5,073 3,322 8,571 1,016 293 566

53 Aetna 1,140 4,941 3,786 6,961 7,221 775 1,014

54 UPMC 1,129 6,223 2,098 4,870 396 517 3,367

57 AmeriHealth 1,261 15,707 4,484 5,054 10,028 657 1,551


Hispanic

51 Gateway 273 6,682 879 5,932 79 4 8

52 United 824 3,024 377 1,862 107 1 6

53 Aetna 141 1,916 244 1,071 687 15 10

54 UPMC 133 2,544 159 731 26 1 37

57 AmeriHealth 167 25,642 413 1,528 1,897 19 13

Lehigh/Capital MCOs 1,538 39,808 2,072 11,124 2,796 40 74

TOTAL 12,429 79,550 26,405 57,473 22,406 2,429 6,985



23


Lehigh/Capital cont.

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

Other/Unknown

51 Gateway 11 3 10 3 1 11 67

52 United 2 2 2 4 0 17 59

53 Aetna 2 1 3 4 0 5 32

54 UPMC 12 1 7 5 0 4 44

57 AmeriHealth 26 0 21 19 1 8 107


Non-Hispanic

51 Gateway 16,816 8,540 9,793 7,862 3,307 17,615 108,370

52 United 7,523 1,278 2,950 2,242 652 15,668 52,797

53 Aetna 2,735 1,313 1,421 1,666 697 6,564 40,234

54 UPMC 7,738 1,405 3,557 2,088 414 6,137 39,939

57 AmeriHealth 18,689 1,702 18,898 17,029 1,030 10,974 107,064


Hispanic

51 Gateway 4,717 4,977 11,287 4,195 73 2,821 41,927

52 United 2,921 511 2,286 568 25 5,225 17,737

53 Aetna 528 484 883 394 36 1,127 7,536

54 UPMC 1,957 563 1,819 550 13 1,166 9,699

57 AmeriHealth 10,512 1,636 19,563 7,236 22 3,633 72,281


TOTAL 74,189 22,416 72,500 43,865 6,271 70,975 497,893



24


Northwest

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

Other/Unknown

35 UPMC 0 3 3 4 0 12 0

36 Gateway 0 0 0 0 0 2 0

37 AmeriHealth 0 2 0 1 0 3 0

56 Aetna 0 0 1 3 0 2 0


Non-Hispanic

35 UPMC 782 4,090 9,817 11,703 3,404 30,245 564

36 Gateway 26 688 1,282 900 371 11,938 82

37 AmeriHealth 102 530 1,955 1,002 271 5,343 75

56 Aetna 40 578 1,703 1,068 273 8,876 44

Northwest MCOs 950 5,886 14,757 14,673 4,319 56,402 765

Hispanic

35 UPMC 23 29 67 146 42 2,123 1

36 Gateway 1 0 5 9 0 1,269 4

37 AmeriHealth 3 3 21 15 7 372 0

56 Aetna 0 13 22 16 5 798 1

Northwest MCOs 27 45 115 186 54 4,562 6

TOTAL 977 5,936 14,876 14,867 4,373 60,983 771



25


Northwest cont.

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

Other/Unknown

35 UPMC 6 0 9 3 3 2 45

36 Gateway 0 0 1 0 1 0 4

37 AmeriHealth 0 1 8 1 1 0 17

56 Aetna 0 0 0 0 0 0 6


Non-Hispanic

35 UPMC 6,327 6,101 13,691 1,684 6,868 4,587 99,863

36 Gateway 784 232 3,512 31 733 641 21,220

37 AmeriHealth 331 1,184 2,105 1,206 945 710 15,759

56 Aetna 345 626 2,033 58 905 441 16,990

Northwest MCOs 7,787 8,143 21,341 2,979 9,451 6,379 153,832

Hispanic

35 UPMC 73 72 170 15 69 31 2,861

36 Gateway 1 0 35 0 8 5 1,337

37 AmeriHealth 3 8 20 9 16 4 481

56 Aetna 3 1 18 1 9 6 893

Northwest MCOs 80 81 243 25 102 46 5,572

TOTAL 7,873 8,225 21,602 3,008 9,558 6,427 159,476



26


Northeast

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

Other/Unknown

41 AmeriHealth NE 4 3 3 1 0 1 6 4

44 Geisinger 3 0 11 1 0 1 20 16

50 Aetna 2 0 5 0 0 0 4 4

Northeast MCOs 9 3 19 2 0 2 30 24

Non-Hispanic

41 AmeriHealth NE 2,951 7,040 2,372 1,103 1,439 707 6,183 11,801

44 Geisinger 4,303 2,279 5,757 4,874 6,657 1,570 25,390 34,314

50 Aetna 3,244 859 2,402 751 1,089 577 4,735 6,836

Northeast MCOs 10,498 10,178 10,531 6,728 9,185 2,854 36,308 52,951

Hispanic

41 AmeriHealth NE 40 631 70 31 92 96 1,504 6,609

44 Geisinger 65 199 138 83 256 154 5,231 10,238

50 Aetna 34 74 67 19 72 78 947 1,626

Northeast MCOs 139 904 275 133 420 328 7,682 18,473

TOTAL 10,646 11,085 10,825 6,863 9,605 3,184 44,020 71,448




Northeast cont.

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

Other/Unknown

41 AmeriHealth NE 3 1 5 0 0 0 2 0

44 Geisinger 6 0 9 0 2 12 3 3

50 Aetna 1 0 4 0 2 1 2 0

Northeast MCOs 10 1 18 0 4 13 7 3

Non-Hispanic

41 AmeriHealth NE 4,953 2,001 12,295 313 2,931 2,364 7,776 1,111

44 Geisinger 14,300 4,253 9,205 1,463 9,689 4,522 12,699 2,890

50 Aetna 1,475 1,494 3,924 281 3,215 1,122 2,713 810

Northeast MCOs 20,728 7,748 25,424 2,057 15,835 8,008 23,188 4,811

Hispanic

41 AmeriHealth NE 114 67 2,911 23 346 481 1,176 29

44 Geisinger 259 119 2,275 57 797 592 1,261 103

50 Aetna 26 89 1,088 7 290 213 238 19

Northeast MCOs 399 275 6,274 87 1,433 1,286 2,675 151

TOTAL 21,137 8,024 31,716 2,144 17,272 9,307 25,870 4,965



28


Northeast cont.

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

Other/Unknown

41 AmeriHealth NE 0 0 1 0 1 0 35

44 Geisinger 0 0 0 2 0 4 93

50 Aetna 0 0 0 0 1 0 26

Northeast MCOs 0 0 1 2 2 4 154

Non-Hispanic

41 AmeriHealth NE 129 1,177 5,696 789 1,583 750 77,464

44 Geisinger 428 4,343 919 2,354 5,291 3,196 160,696

50 Aetna 141 916 536 662 1,102 538 39,422

Northeast MCOs 698 6,436 7,151 3,805 7,976 4,484 277,582

Hispanic

41 AmeriHealth NE 0 20 67 68 105 15 14,495

44 Geisinger 11 94 5 226 210 80 22,453

50 Aetna 0 10 7 30 59 5 4,998

Northeast MCOs 11 124 79 324 374 100 41,946

TOTAL 709 6,560 7,231 4,131 8,352 4,588 319,682



29

Mandatory PLAN MAKE UP BY AGE GROUP AND GENDER March 2019

SOUTHEAST

42 United 43 Aetna 45 Health

Partners 47 Keystone TOTAL

< 21 Yrs

Female 21,269 16,575 58,068 116,451 212,363

Male 22,072 18,029 59,567 125,678 225,346

Total 43,341 34,604 117,635 242,129 437,709

22-45 Yrs

Female 17,015 12,650 50,166 79,341 159,172

Male 15,051 12,694 29,984 45,828 103,557

Total 32,066 25,344 80,150 125,169 262,729

46-64 Yrs

Female 6,370 4,084 20,694 31,340 62,488

Male 7,343 5,364 18,236 27,633 58,576

Total 13,713 9,448 38,930 58,973 121,064

Over 64 Yrs

Female 370 270 1,021 1,619 3,280

Male 254 169 577 989 1,989

Total 624 439 1,598 2,608 5,269

TOTAL 89,744 69,835 238,313 428,879 826,771

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs

Female 29,204 15,943 65,017 4,729 114,893

Male 31,230 17,182 69,586 4,931 122,929

Total 60,434 33,125 134,603 9,660 237,822

22-45 Yrs

Female 22,558 12,180 54,683 4,792 94,213

Male 12,985 8,702 33,565 4,551 59,803

Total 35,543 20,882 88,248 9,343 154,016

46-64 Yrs

Female 9,747 4,955 26,023 1,684 42,409

Male 7,480 4,616 20,772 2,124 34,992

Total 17,227 9,571 46,795 3,808 77,401

Over 64 Yrs

Female 130 59 401 27 617

Male 88 42 255 29 414

Total 218 101 656 56 1,031

TOTAL 113,422 63,679 270,302 22,867 470,270


30


LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57

AmeriHealth TOTAL

< 21 Yrs

Female 42,880 19,465 11,761 12,607 49,607 136,320

Male 45,612 20,672 12,618 13,552 52,319 144,773

Total 88,492 40,137 24,379 26,159 101,926 281,093

22-45 Yrs

Female 28,908 13,204 9,955 9,892 35,745 97,704

Male 13,793 8,057 6,862 6,457 17,287 52,456

Total 42,701 21,261 16,817 16,349 53,032 150,160

46-64 Yrs

Female 10,880 4,880 3,354 3,746 14,234 37,094

Male 7,645 4,011 3,072 3,199 9,357 27,284

Total 18,525 8,891 6,426 6,945 23,591 64,378

Over 64 Yrs

Female 424 186 115 131 610 1,466

Male 222 118 65 98 293 796

Total 646 304 180 229 903 2,262

TOTAL 150,364 70,593 47,802 49,682 179,452 497,893

NORTHWEST

31 UPMC 32 Gateway 34 Amerihealth 59 Aetna TOTAL

< 21 Yrs

Female 26,473 5,687 3,655 4,430 40,245

Male 27,958 5,977 3,921 4,602 42,458

Total 54,431 11,664 7,576 9,032 82,703

22-45 Yrs

Female 20,244 4,491 3,359 3,544 31,638

Male 11,966 3,020 2,504 2,662 20,152

Total 32,210 7,511 5,863 6,206 51,790

46-64 Yrs

Female 9,308 1,795 1,443 1,402 13,948

Male 6,706 1,573 1,348 1,222 10,849

Total 16,014 3,368 2,791 2,624 24,797

Over 64 Yrs

Female 62 12 16 13 103

Male 52 6 11 14 83

Total 114 18 27 27 186

TOTAL 102,769 22,561 16,257 17,889 159,476


31


NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs

Female 23,399 46,909 10,894 81,202

Male 24,481 49,572 11,627 85,680

Total 47,880 96,481 22,521 166,882

22-45 Yrs

Female 18,834 36,776 8,919 64,529

Male 10,995 21,022 6,555 38,572

Total 29,829 57,798 15,474 103,101

46-64 Yrs

Female 8,019 16,355 3,455 27,829

Male 6,009 12,150 2,894 21,053

Total 14,028 28,505 6,349 48,882

Over 64 Yrs

Female 169 296 64 529

Male 88 162 38 288

Total 257 458 102 817

TOTAL 91,994 183,242 44,446 319,682


Mandatory PLAN MAKE UP BY AGE GROUP March 2019

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs 43,341 34,604 117,635 242,129 437,709

22-45 Yrs 32,066 25,344 80,150 125,169 262,729

46-64 Yrs 13,713 9,448 38,930 58,973 121,064

Over 64 Yrs 624 439 1,598 2,608 5,269

TOTAL 89,744 69,835 238,313 428,879 826,771

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs 60,434 33,125 134,603 9,660 237,822

22-45 Yrs 35,543 20,882 88,248 9,343 154,016

46-64 Yrs 17,227 9,571 46,795 3,808 77,401

Over 64 Yrs 218 101 656 56 1,031

TOTAL 113,422 63,679 270,302 22,867 470,270

LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs 88,492 40,137 24,379 26,159 101,926 281,093

22-45 Yrs 42,701 21,261 16,817 16,349 53,032 150,160

46-64 Yrs 18,525 8,891 6,426 6,945 23,591 64,378

Over 64 Yrs 646 304 180 229 903 2,262

TOTAL 150,364 70,593 47,802 49,682 179,452 497,893


33

Mandatory PLAN MAKE UP BY AGE GROUP March 2019

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 54,431 11,664 7,576 9,032 82,703

22-45 Yrs 32,210 7,511 5,863 6,206 51,790

46-64 Yrs 16,014 3,368 2,791 2,624 24,797

Over 64 Yrs 114 18 27 27 186

TOTAL 102,769 22,561 16,257 17,889 159,476

NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs 47,880 96,481 22,521 166,882

22-45 Yrs 29,829 57,798 15,474 103,101

46-64 Yrs 14,028 28,505 6,349 48,882

Over 64 Yrs 257 458 102 817

TOTAL 91,994 183,242 44,446 319,682


34

HealthChoices Enrollment AID CATEGORY DISTRIBUTION 1st Quarter 2018

Southeast

TANF/HB/MAGI (Ages 21+)

12%

TANF/HB/MAGI (Ages 1 -20)

37%

Under Age 1 3%

Disabled/BC&C 15%

Newly Eligible (45+) 12%

Newly Eligible (19-44)

21%

Southwest


36%

Disabled/BC&C 17%



20%

Under Age 1 3%


11%

Lehigh/Capital


42%Disabled/BC&C 14%



19%

Under Age 1 3%


11%

Northwest


38%

Disabled/BC&C 17%



21%

Under Age 1 3%


11% Northeast


12%


39%

Under Age 1 3%

Disabled/BC&C 14%



22%

Source: Bureau of Fiscal Management

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 March 2019

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.

March 2019

Zone Percentage

Southeast 92.6%

Southwest 93.2%

Lehigh/Capital 93.9%

Northwest 94.5%

Northeast 94.5%

Total 93.5%

Source: Maximus

36

Medical Assistance Transportation Program

37

Based on Data Submitted by Each County

MATP 1Q FY 17/18

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips

Mileage

Reimbursement

Trips

Total Trips Client Utilization

Bucks $ 586,899 18,736 - 17,200 35,936 1.1%

Chester $ 569,308 12,310 2,873 4,589 19,772 1.7%

Delaware $ 1,221,922 24,152 - 9,690 33,842 1.1%

Montgomery $ 859,295 19,781 2,996 4,531 27,308 1.3%

Philadelphia $ 11,671,583 273,483 820,415 12,951 1,106,849 3.4%

HC-SE Zone $ 14,909,006 348,462 826,284 48,961 1,223,707 2.7%

38

MATP 1Q FY 17/18

Southwest


Mileage

Reimbursement

Trips


Allegheny $ 2,446,268 56,476 161,146 39,456 257,078 4.0%

Armstrong $ 457,304 9,434 - 4,642 14,076 5.2%

Beaver $ 693,831 15,480 357 20,672 36,509 3.2%

Bedford $ 126,695 4,099 - 3,765 7,864 3.9%

Blair $ 318,733 11,338 2,203 3,599 17,140 2.8%

Butler $ 626,004 12,624 - 5,025 17,649 2.8%

Cambria $ 1,001,339 30,703 5,313 4,513 40,529 1.0%

Fayette $ 371,134 16,349 20 20,839 37,208 3.1%

Greene $ 186,920 4,611 - 3,088 7,699 3.1%

Indiana $ 230,357 5,636 600 3,595 9,831 3.1%

Lawrence $ 293,182 6,702 3,273 13,348 23,323 3.4%

Somerset $ 393,200 8,024 - 5,844 13,868 3.6%

Washington $ 598,168 17,810 1,709 13,310 32,829 4.1%

Westmoreland $ 778,065 23,392 290 16,299 39,981 2.7%

HC-SW Zone $ 8,521,199 222,678 174,911 157,995 555,584 3.4%

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MATP 1Q FY 17/18

Lehigh/Capital


Mileage

Reimbursement

Trips


Adams* $ 54,269 1,502 - 1,144 2,646 1.0%

Berks $ 887,347 19,429 10,892 5,244 35,565 1.7%

Cumberland $ 137,786 4,835 - 1,883 6,718 1.1%

Dauphin $ 757,087 25,067 5,550 1,610 32,227 2.8%

Franklin $ 110,282 3,554 - 1,823 5,377 1.1%

Fulton $ 124,108 1,724 - 1,615 3,339 7.7%

Huntingdon $ 180,553 3,007 - 5,846 8,853 5.3%

Lancaster $ 676,494 20,883 640 5,591 27,114 1.0%

Lebanon $ 393,806 17,523 348 1,127 18,998 1.7%

Lehigh $ 593,920 14,505 2,064 1,450 18,019 1.1%

Northampton $ 302,923 8,368 908 1,304 10,580 1.1%

Perry $ 67,704 2,711 - 590 3,301 2.1%

York* $ 238,736 7,514 362 3,764 11,640 0.7%

HC-L/C Zone $ 4,525,016 130,622 20,764 32,991 184,377 1.4%

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

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MATP 1Q FY 17/18

Northwest

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Cameron $ 68,403 1,066 132 297 1,495 4.8%

Clarion $ 167,951 2,341 - 2,183 4,524 3.6%

Clearfield $ 332,226 10,038 - 6,717 16,755 4.4%

Crawford $ 241,940 1,536 893 10,008 12,437 4.3%

Elk $ 180,766 3,019 2 1,012 4,033 4.7%

Erie $ 477,943 18,403 824 4,006 23,233 0.9%

Forest $ 30,188 494 - 249 743 3.5%

Jefferson $ 404,661 9,437 22 4,186 13,645 7.0%

McKean $ 146,000 2,486 20 812 3,318 2.6%

Mercer $ 248,194 10,205 15 2,138 12,358 2.6%

Potter $ 218,615 2,618 - 1,190 3,808 5.9%

Venango $ 263,531 4,441 40 2,060 6,541 3.6%

Warren $ 95,257 1,320 33 1,919 3,272 6.4%

HC-Northwest Zone $ 2,875,675 67,404 1,981 36,777 106,162 3.0%

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MATP 1Q FY 17/18

Northeast

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Bradford/Tioga $ 439,706 6,670 286 1,738 8,694 3.2%

Carbon $ 208,386 3,574 - 381 3,955 2.8%

Centre $ 146,940 4,077 235 1,640 5,952 1.9%

Clinton $ 254,376 4,068 - 934 5,002 3.8%

Columbia $ 98,427 2,760 - 2,039 4,799 1.9%

Juniata $ 29,830 720 - 346 1,066 1.2%

Lackawanna $ 250,711 7,170 2,028 2,954 12,152 1.1%

Luzerne $ 425,714 18,487 824 7,370 26,681 1.6%

Lycoming $ 431,668 10,159 2,095 3,379 15,633 3.7%

Mifflin $ 103,855 3,597 - 730 4,327 2.4%

Monroe $ 506,458 19,781 2,996 4,531 27,308 3.7%

Montour $ 39,420 1,170 - 752 1,922 2.7%

Northumberland $ 217,857 7,963 - 2,659 10,622 3.2%

Pike $ 74,077 1,224 - 2,632 3,856 1.1%

Schuylkill $ 336,427 5,237 914 2,448 8,599 1.9%

Snyder $ 41,328 1,419 - 596 2,015 1.9%

Sullivan $ - - - - - 0.0%

Susquehanna $ 142,748 2,286 - 1,558 3,844 3.4%

Union $ 23,484 897 - 248 1,145 1.8%

Wayne $ 176,733 4,289 - 1,160 5,449 3.5%

Wyoming $ 75,596 2,000 - 708 2,708 2.4%

HC-Northeast Zone $ 4,023,742 107,548 9,378 38,803 155,729 2.3%

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.

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