Pennsylvania does not participate in Medicaid Expansion under provisions of the Affordable Care Act (ACA). For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.
Medicaid in Pennsylvania
The Pennsylvania Department of Public Welfare administers the Medicaid Program, called Medical Assistance Programs. Information about Medical Assistance Programs can be found at: http://www.dpw.state.pa.us/foradults/healthcaremedicalassistance/.
Provider Participation
Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services. Information about enrolling in the Medical Assistance Programs fee-for-service program can be found at: http://www.dpw.state.pa.us/provider/promise/enrollmentinformation/.
The Medical Assistance Programs’ website provides information about services covered by fee-for-service payments and payment amounts: http://www.dpw.state.pa.us/foradults/healthcaremedicalassistance/.
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.
Basic information about HealthChoices can be found at: http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/managedcareinformation/.
Some managed care plans cover individual Pennsylvania counties and independent cities. The Medical Assistance Programs website has jurisdictional information: http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/managedcareinformation/.
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.
Reporting Problems
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:
800-692-7462
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
Plan Website: http://www.aetnabetterhealth.com/pennsylvania/
Provider Enrollment: http://www.aetnabetterhealth.com/pennsylvania/providers/join-our-network
AmeriHealth Caritas PA
Plan Website: http://www.amerihealthcaritaspa.com/
Provider Enrollment: http://www.amerihealthcaritaspa.com/provider/services/credentialing/index.aspx
AmeriHealth Northeast
Plan Website: http://www.amerihealthnortheast.com/
Provider Enrollment: http://www.amerihealthnortheast.com/provider/services/credentialing/index.aspx
Coventry Cares Health Plan
Plan Website: http://www.mycoventrycares.com/
Provider Enrollment: http://chcmedicaid-pennsylvania.coventryhealthcare.com/for-providers/provider-inquiries/index.htm
Gateway Health
Plan Website: http://www.gatewayhealthplan.com/medical-assistance-medicaid
Provider Enrollment: http://gatewayhealthplan.com/contact/enroll-as-new-provider
Geisinger Health Plan (Geisinger Family)
Plan Website: http://www.thehealthplan.com/
Provider Enrollment: http://www.thehealthplan.com/providers_us/providerjoin.cfm
Health Partners of Philadelphia, Inc.
Plan Website: http://www.healthpart.com/
Provider Enrollment: http://www.healthpart.com/ProviderRecruitment.asp
Keystone First
Plan Website: http://www.keystonefirstpa.com/
Provider Enrollment: http://www.keystonefirstpa.com/provider/services/credentialing/index.aspx
MPMC Health Plan, Inc., UPMC For You
Plan Website: http://www.mpmc.org/
Provider Enrollment: Not available
United Healthcare Community Plan of PA
Plan Website: http://www.uhccommunityplan.com/plan/state/PA/index
Provider Enrollment: http://www.uhccommunityplan.com/physicians-network
UPMC Health Plan, Inc., UPMC For You
Plan Website: http://www.mpmc.org/
Provider Enrollment: N/A