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Department of Human Services Announces Health Plans Selected for HealthChoices Program and Some Plans Protest

In July 2020, the Pennsylvania Department of Human Services (DHS) announced applicants selected through a Request for Applications (RFA) for Pennsylvania’s HealthChoices program, the Medicaid physical health managed care program that provides healthcare coverage to more than 2.6 million people.  However, DHS is unable to move forward with the selections due to the pendency of protests.    

The delay is not surprising.  Readers may recall that the procurement process for the physical HealthChoices has been fraught due to protests and lawsuits filed by Managed Care Organizations’ (MCOs) who lost their bids to manage Medicaid benefits.  Rather than issuing separate procurements for each region, as it had done in the past, DHS combined the contracting process for all its regional zones.  This change, combined with the program’s enrollment growth, following Medicaid expansion, has attracted unprecedented interest and bids from both regional and national insurance companies.  In Pennsylvania, these contracts are worth billions of dollars per year.     

Current enrollment by zone, county and managed care plan can be found here.  The current HealthChoices program has been operating under extensions of contracts originally awarded in 2012.  

In October 2019, the Department re-issued Request for Applications (RFA) again seeking MCOs to administer HealthChoices in all five zones.  Again, in July 2020, DHS announced the applicants selected to serve PA’s HealthChoices Physical Health program.  Selected applicants for each service zone are: 

  • Southeast: Geisinger Health Plan, Health Partners Plans, United HealthCare, UPMC for You, and Vista Health Plan (Keystone First), 

  • Lehigh/Capital: Gateway Health, Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas), 

  • Northeast: Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas), 

  • Northwest: Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas), and 

  • Southwest: Gateway Health, Geisinger Health Plan, Health Partners Plans, UPMC for You, and Vista Health Plan (AmeriHealth Caritas). 

DHS reported at the July meeting of the Medical Assistance Advisory Committee that four of the bidding managed care plans filed protests: Aetna Better Health, Gateway Health, PA Health & Wellness (Centene) and UnitedHealthcare.  These protests halt the process from moving forward.  DHS cannot begin the “readiness review” process or award the contracts to the selected plans. 

Readers interested in more information on the HealthChoices procurement and requirements of the RFA, can view it here.  

The existing health plans remain in place until the protests are resolved.  Current HealthChoices plans per region are: 

  • Southeast:  Aetna Better Health, Health Partners, Keystone First and UnitedHealthcare 

  • Lehigh/Capital:  Aetna Better Health, AmeriHealth Caritas, Gateway Health, UnitedHealthcare, UPMC for You 

  • Northeast:  Aetna Better Health, AmeriHealth Caritas Northeast, Geisinger Health Plan 

  • Northwest:  Aetna Better Health, AmeriHealth Caritas, Gateway Health, UPMC for You 

  • Southwest:  Aetna Better Health, Gateway Health, UnitedHealthcare, UPMC for You 

PHLP will keep readers abreast as the procurement process evolves.