For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.
Medicaid in Pennsylvania:
In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually.
Medicaid Managed Care:
Some Pennsylvania Medicaid Program beneficiaries are enrolled in managed care plans, called HealthChoices.
Pennsylvania HealthChoices Beneficiaries Participating in Managed Care:
Managed care plans participating in HealthChoices offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.
The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
Managed Care Plans Participating in HealthChoices:
Aetna Better Health
AmeriHealth Caritas PA
Coventry Cares Health Plan
Plan Website: http://www.gatewayhealthplan.com/medical-assistance-medicaid
Geisinger Health Plan (Geisinger Family)
Health Partners of Philadelphia, Inc.
MPMC Health Plan, Inc., UPMC For You
Provider Enrollment: Not available
United Healthcare Community Plan of PA
UPMC Health Plan, Inc., UPMC For You
Provider Enrollment: N/A