BMCO Monthly Physical Health Managed Care Program ......BMCO Monthly Physical Health Managed Care...

BMCO Monthly Physical Health Managed Care Program Enrollment Report

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.

Released: December 16, 2020

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

Table of Contents

2

3

HealthChoices

Managed Care

Erie

Crawford

Mercer

Warren McKean Potter Tioga Bradford Susquehanna Wayne

Pike

Lackawanna

Monroe Luzerne

Wyoming

Carbon

Schuylkill

Columbia

Sullivan Lycoming

Montour Northumberland 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 November 2020

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL 09 Bucks 6,485 8,659 14,310 45,258 74,712 15 Chester 14,757 8,457 3,734 25,506 52,454 23 Delaware 9,987 11,375 10,322 76,876 108,560 46 Montgomery 10,314 12,173 12,310 62,247 97,044 51 Philadelphia 58,348 42,020 210,322 259,952 570,642 TOTAL 99,891 82,684 250,998 469,839 903,412 PERCENTAGE 11% 9% 28% 52%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL 02 Allegheny 59,045 23,717 112,593 10,616 205,971 03 Armstrong 1,102 715 10,457 516 12,790 04 Beaver 10,742 2,845 14,889 1,559 30,035 05 Bedford 735 1,161 6,507 694 9,097 07 Blair 5,599 3,451 15,840 2,196 27,086 10 Butler 4,760 1,435 15,430 1,114 22,739 11 Cambria 3,607 5,188 16,767 2,848 28,410 26 Fayette 3,837 8,819 21,083 948 34,687 30 Greene 823 2,987 3,762 392 7,964 32 Indiana 2,306 1,905 9,732 765 14,708 37 Lawrence 6,569 1,746 9,787 876 18,978 56 Somerset 1,671 2,751 7,390 1,076 12,888 63 Washington 5,608 5,701 21,513 1,964 34,786 65 Westmoreland 10,820 8,102 35,236 2,629 56,787 TOTAL 117,224 70,523 300,986 28,193 516,926 PERCENTAGE 23% 14% 58% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 12/10/20 5

Source: PA Department of Human Services Enterprise Data Warehouse Updated 12/10/20


cont. LEHIGH/CAPITAL

County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL 01 Adams 3,929 4,867 1,529 1,555 1,613 13,493 06 Berks 14,756 9,698 8,597 10,759 43,942 87,752 21 Cumberland 12,302 4,662 5,140 4,228 5,836 32,168 22 Dauphin 27,944 11,805 9,750 9,371 7,822 66,692 28 Franklin 1,404 2,290 8,821 783 12,498 25,796 29 Fulton 194 399 817 566 727 2,703 31 Huntingdon 453 710 1,159 3,570 1,733 7,625 36 Lancaster 23,661 12,022 4,273 12,895 31,681 84,532 38 Lebanon 14,689 2,325 2,276 2,739 3,859 25,888 39 Lehigh 22,825 6,572 4,268 6,153 43,132 82,950 48 Northampton 12,444 3,221 3,083 3,138 27,142 49,028 50 Perry 3,416 698 918 715 1,162 6,909 67 York 21,484 22,929 10,051 10,279 16,438 81,181 TOTAL 159,501 82,198 60,682 66,751 197,585 566,717 PERCENTAGE 28% 15% 11% 12% 35%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL 12 Cameron 846 32 113 59 1,050 16 Clarion 4,738 678 599 619 6,634 17 Clearfield 10,608 1,283 2,334 2,000 16,225 20 Crawford 12,909 1,015 1,199 1,222 16,345 24 Elk 3,936 471 375 371 5,153 25 Erie 34,623 13,213 6,362 10,553 64,751 27 Forest 613 89 65 54 821 33 Jefferson 6,981 863 394 484 8,722 42 McKean 6,449 253 1,303 720 8,725 43 Mercer 15,086 3,574 2,381 2,170 23,211 53 Potter 1,881 57 1,262 101 3,301 61 Venango 7,372 788 1,048 1,004 10,212 62 Warren 4,944 743 838 511 7,036

TOTAL 110,986 23,059 18,273 19,868 172,186 PERCENTAGE 64% 13% –11% 12%

6


cont.

NORTHEAST County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 3,694 4,944 3,406 12,044 13 Carbon 8,699 2,587 1,189 12,475 14 Centre 2,756 6,729 2,769 12,254 18 Clinton 1,267 5,197 854 7,318 19 Columbia 1,724 7,547 1,365 10,636 34 Juniata 886 1,857 694 3,437 35 Lackawanna 8,923 33,703 6,636 49,262 40 Luzerne 20,906 50,340 9,767 81,013 41 Lycoming 5,368 15,833 2,072 23,273 44 Mifflin 2,238 4,821 1,709 8,768 45 Monroe 17,022 12,826 5,705 35,553 47 Montour 402 1,663 317 2,382 49 Northumberland 3,894 12,092 3,725 19,711 52 Pike 3,118 5,617 1,589 10,324 54 Schuylkill 10,636 14,661 3,282 28,579 55 Snyder 1,221 3,492 882 5,595 57 Sullivan 168 557 160 885 58 Susquehanna 1,376 4,870 1,076 7,322 59 Tioga 6,440 1,074 655 8,169 60 Union 917 3,005 717 4,639 64 Wayne 1,852 5,978 1,342 9,172 66 Wyoming 847 3,805 598 5,250

TOTAL 104,354 203,198 50,509 358,061 PERCENTAGE 29% 57% 14%


Mandatory MARKET SHARE BY PLAN – STATEWIDE November 2020

Total Enrollment = 2,517,302

AmeriHealth NE

Aetna 241,936

10%

AmeriHealth 215,858

8%

Gateway 299,784

12%

Health Partners 250,998

10%

Keystone 469,839

19%

United 252,612

10%

UPMC 478,723

19%

104,354 4%

Geisinger 203,198

8%


-

-

Aetna 19,868

12%

Gateway 23,059

13%

UPMC 110,986

64%

Mandatory MARKET SHARE BY ZONE AND BY PLAN November 2020

Aetna Southeast Southwest 28,193

5%

Lehigh/Capital

Northwest

Aetna 60,682

11%

Ameri Health

197,585 35%

Gateway 159,501

28%

United 82,198

14%

Northeast

UPMC 66,751

12%

Ameri-Health 18,273

11%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 12/10/20

Aetna 82,684

9%

Health Partners 250,998

28%

Keystone 469,839

52%

United 99,891

11% Gateway 117,224

23%

United 70,523

14%

UPMC 300,986

58%

Aetna 50,509

14%

Ameri Health NE 104,354

29%

Geisinger 203,198

57%

9

Mandatory ENROLLMENT BY PLAN, BY RACE AND BY COUNTY November 2020

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

Black or African American

42 United 750 2,623 5,145 2,481 35,492 46,491 43 Aetna 868 1,373 5,170 2,550 25,053 35,014 45 Health Partners 1,609 601 5,392 3,400 98,715 109,717 47 Keystone 4,760 4,243 36,826 14,440 154,870 215,139 Southeast MCOs 7,987 8,840 52,533 22,871 314,130 406,361

American Indian or Alaskan Native

42 United 15 50 24 44 130 263 43 Aetna 37 54 29 76 109 305 45 Health Partners 44 14 34 49 297 438 47 Keystone 110 111 136 211 524 1,092 Southeast MCOs 206 229 223 380 1,060 2,098

Asian

42 United 306 373 518 559 3,505 5,261 43 Aetna 390 235 587 863 1,903 3,978 45 Health Partners 932 109 481 939 8,450 10,911 47 Keystone 1,689 850 5,226 4,350 21,035 33,150 Southeast MCOs 3,317 1,567 6,812 6,711 34,893 53,300

White

42 United 4,193 8,110 3,073 5,091 8,963 29,430 43 Aetna 5,868 5,109 4,314 6,503 7,579 29,373 45 Health Partners 8,856 2,209 2,967 5,611 34,192 53,835 47 Keystone 31,448 15,347 26,592 31,398 42,359 147,144 Southeast MCOs 50,365 30,775 36,946 48,603 93,093 259,782

Other or system default

42 United 796 2,471 762 1,463 7,800 13,292 43 Aetna 945 1,057 766 1,391 5,548 9,707 45 Health Partners 2,053 498 991 1,649 61,483 66,674 47 Keystone 5,159 3,416 5,348 8,635 32,549 55,107 Southeast MCOs 8,953 7,442 7,867 13,138 107,380 144,780

Native Hawaiian or Other Pacific Islander

42 United 28 30 24 42 201 325 43 Aetna 36 19 31 41 138 265 45 Health Partners 42 17 20 41 497 617 47 Keystone 76 45 105 122 358 706 Southeast MCOs 182 111 180 246 1,194 1,913

Unknown

42 United 397 1,100 441 634 2,257 4,829 43 Aetna 515 610 478 749 1,690 4,042 45 Health Partners 774 286 437 621 6,688 8,806 47 Keystone 2,016 1,494 2,643 3,091 8,257 17,501 Southeast MCOs 3,702 3,490 3,999 5,095 18,892 35,178

MCO TOTAL

42 United 6,485 14,757 9,987 10,314 58,348 99,891 43 Aetna 8,659 8,457 11,375 12,173 42,020 82,684 45 Health Partners 14,310 3,734 10,322 12,310 210,322 250,998 47 Keystone 45,258 25,506 76,876 62,247 259,952 469,839

TOTAL 74,712 52,454 108,560 97,044 570,642 903,412 Racial/Ethnic information is self-reported by consumers.


10


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


31 Gateway 28,630 28 2,670 14 404 202 578 358 32 United 9,484 17 586 16 265 69 1,107 848 34 UPMC 35,958 152 2,420 77 863 433 1,615 1,709 59 Aetna 3,883 8 331 16 136 38 789 97 Southwest MCOs 77,955 205 6,007 123 1,668 742 4,089 3,012


31 Gateway 167 0 23 1 7 6 15 4 32 United 85 3 2 0 9 6 3 9 34 UPMC 417 21 61 9 28 30 35 53 59 Aetna 37 2 9 3 6 21 2 6 Southwest MCOs 706 26 95 13 50 63 55 72

Asian

31 Gateway 831 3 20 0 9 20 12 14 32 United 624 2 30 9 36 22 16 13 34 UPMC 5,882 34 122 27 94 169 46 59 59 Aetna 300 1 10 2 10 17 7 2 Southwest MCOs 7,637 40 182 38 149 228 81 88

White

31 Gateway 25,320 1,046 7,715 698 5,080 4,364 2,886 3,345 32 United 11,172 661 2,027 1,114 3,048 1,222 3,846 7,679 34 UPMC 58,634 10,074 11,512 6,243 14,450 13,910 14,439 18,588 59 Aetna 4,913 485 1,090 650 1,972 947 1,924 781 Southwest MCOs 100,039 12,266 22,344 8,705 24,550 20,443 23,095 30,393


31 Gateway 2,042 6 222 14 62 85 61 57 32 United 1,159 18 118 13 45 70 130 112 34 UPMC 6,170 81 453 110 203 430 354 270 59 Aetna 738 11 71 14 39 48 71 36 Southwest MCOs 10,109 116 864 151 349 633 616 475



Unknown

31 Gateway 2,020 19 89 8 36 75 53 53 32 United 1,147 14 78 9 48 44 74 146 34 UPMC 5,317 91 312 41 194 438 268 388 59 Aetna 702 9 42 8 32 43 49 22 Southwest MCOs 9,186 133 521 66 310 600 444 609

MCO TOTAL

31 Gateway 59,045 1,102 10,742 735 5,599 4,760 3,607 3,837 32 United 23,717 715 2,845 1,161 3,451 1,435 5,188 8,819 34 UPMC 112,593 10,457 14,889 6,507 15,840 15,430 16,767 21,083 59 Aetna 10,616 516 1,559 694 2,196 1,114 2,848 948

TOTAL 205,971 12,790 30,035 9,097 27,086 22,739 28,410 34,687 Racial/Ethnic information is self-reported by consumers.


11


Southwest cont.

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


31 Gateway 19 88 995 16 713 1,569 36,284 32 United 35 110 243 30 697 806 14,313 34 UPMC 45 307 1,023 84 1,939 2,581 49,206 59 Aetna 6 48 153 19 238 262 6,024 Southwest MCOs 105 553 2,414 149 3,587 5,218 105,827


31 Gateway 0 5 11 4 12 38 293 32 United 2 4 4 7 17 22 173 34 UPMC 8 30 30 9 42 84 857 59 Aetna 1 2 3 3 9 7 111 Southwest MCOs 11 41 48 23 80 151 1,434

Asian

31 Gateway 5 13 6 2 15 50 1,000 32 United 2 7 4 9 26 37 837 34 UPMC 21 67 43 25 174 300 7,063 59 Aetna 1 5 5 5 18 19 402 Southwest MCOs 29 92 58 41 233 406 9,302

White

31 Gateway 783 2,124 5,410 1,610 4,606 8,638 73,625 32 United 2,916 1,721 1,436 2,638 4,688 6,748 50,916 34 UPMC 3,619 8,984 8,331 7,084 18,182 30,153 224,203 59 Aetna 368 656 680 1,019 1,572 2,075 19,132 Southwest MCOs 7,686 13,485 15,857 12,351 29,048 47,614 367,876


31 Gateway 8 40 79 19 130 228 3,053 32 United 20 34 38 41 134 226 2,158 34 UPMC 43 145 223 83 534 876 9,975 59 Aetna 8 32 22 6 63 124 1,283 Southwest MCOs 79 251 362 149 861 1,454 16,469


31 Gateway 0 1 1 1 1 6 65 32 United 0 1 0 0 8 5 90 34 UPMC 1 3 12 0 19 29 346 59 Aetna 1 0 2 0 2 4 70 Southwest MCOs 2 5 15 1 30 44 571

Unknown

31 Gateway 8 35 67 19 131 291 2,904 32 United 12 28 21 26 131 258 2,036 34 UPMC 25 196 125 105 623 1,213 9,336 59 Aetna 7 22 11 24 62 138 1,171 Southwest MCOs 52 281 224 174 947 1,900 15,447

MCO TOTAL

31 Gateway 823 2,306 6,569 1,671 5,608 10,820 117,224 32 United 2,987 1,905 1,746 2,751 5,701 8,102 70,523 34 UPMC 3,762 9,732 9,787 7,390 21,513 35,236 300,986 59 Aetna 392 765 876 1,076 1,964 2,629 28,193

TOTAL 7,964 14,708 18,978 12,888 34,786 56,787 516,926

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 12/10/20

12


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


51 Gateway 129 1,272 1,647 10,758 130 4 18 52 United 219 918 738 4,106 239 6 30 53 Aetna 71 1,011 568 3,036 693 21 59 54 UPMC 67 823 451 2,559 57 16 87 57 AmeriHealth 64 3,477 696 2,119 1,013 23 28 Lehigh/Capital MCOs 550 7,501 4,100 22,578 2,132 70 222


51 Gateway 21 29 39 75 13 1 0 52 United 14 24 24 49 9 0 1 53 Aetna 7 20 26 58 16 1 1 54 UPMC 7 21 19 41 4 0 1 57 AmeriHealth 1 64 27 42 50 2 1 Lehigh/Capital MCOs 50 158 135 265 92 4 4

Asian

51 Gateway 37 170 361 1,541 10 0 1 52 United 41 121 248 1,130 12 0 2 53 Aetna 14 138 198 821 68 3 4 54 UPMC 22 157 277 1,292 3 1 18 57 AmeriHealth 13 287 194 541 94 0 4 Lehigh/Capital MCOs 127 873 1,278 5,325 187 4 29

White

51 Gateway 3,340 6,890 8,161 8,324 1,042 185 419 52 United 3,784 4,998 2,715 3,801 1,620 378 654 53 Aetna 1,192 4,700 3,441 3,775 6,790 767 1,067 54 UPMC 1,234 6,396 2,639 3,435 600 546 3,385 57 AmeriHealth 1,314 14,975 3,913 2,910 8,901 670 1,652 Lehigh/Capital MCOs 10,864 37,959 20,869 22,245 18,953 2,546 7,177


51 Gateway 198 5,595 1,403 5,623 122 1 13 52 United 590 2,943 621 1,875 253 11 16 53 Aetna 147 2,127 527 1,336 691 15 17 54 UPMC 125 2,579 558 1,284 68 3 55 57 AmeriHealth 137 22,534 648 1,499 1,458 24 26 Lehigh/Capital MCOs 1,197 35,778 3,757 11,617 2,592 54 127



Unknown

51 Gateway 197 758 662 1,570 85 3 2 52 United 215 638 299 795 154 4 7 53 Aetna 92 560 361 681 548 10 11 54 UPMC 100 737 261 710 51 0 24 57 AmeriHealth 83 2,448 332 691 959 8 20 Lehigh/Capital MCOs 687 5,141 1,915 4,447 1,797 25 64

MCO TOTAL

51 Gateway 3,929 14,756 12,302 27,944 1,404 194 453 52 United 4,867 9,698 4,662 11,805 2,290 399 710 53 Aetna 1,529 8,597 5,140 9,750 8,821 817 1,159 54 UPMC 1,555 10,759 4,228 9,371 783 566 3,570 57 AmeriHealth 1,613 43,942 5,836 7,822 12,498 727 1,733

TOTAL 13,493 87,752 32,168 66,692 25,796 2,703 7,625

Source: PA Department of Racial/Ethnic Human Services Enterprise information is self- Data Warehouse – Updated

reported by consumers. 12/10/20 13


Lehigh/Capital cont.

Racial/Ethnic information is self-reported by consumers.

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


51 Gateway 2,029 619 3,165 1,722 71 2,527 24,091 52 United 1,487 138 984 435 12 4,065 13,377 53 Aetna 450 117 646 463 36 1,601 8,772 54 UPMC 1,174 152 808 348 26 1,374 7,942 57 AmeriHealth 3,470 160 5,101 3,060 22 2,494 21,727 Lehigh/Capital MCOs 8,610 1,186 10,704 6,028 167 12,061 75,909


51 Gateway 79 18 30 31 2 108 446 52 United 30 1 12 11 0 89 264 53 Aetna 12 5 9 20 4 59 238 54 UPMC 44 12 9 13 2 77 250 57 AmeriHealth 68 5 72 98 1 89 520 Lehigh/Capital MCOs 233 41 132 173 9 422 1,718

Asian

51 Gateway 869 162 354 221 4 231 3,961 52 United 359 67 174 80 2 280 2,516 53 Aetna 106 36 100 86 7 167 1,748 54 UPMC 494 76 198 72 3 144 2,757 57 AmeriHealth 818 55 736 590 4 195 3,531 Lehigh/Capital MCOs 2,646 396 1,562 1,049 20 1,017 14,513

White

51 Gateway 14,456 9,520 15,050 7,230 3,217 15,024 92,858 52 United 6,443 1,462 3,977 2,007 629 12,737 45,205 53 Aetna 2,689 1,566 2,589 1,865 826 6,248 37,515 54 UPMC 7,712 1,856 3,891 1,989 625 6,553 40,861 57 AmeriHealth 15,661 2,065 28,947 17,030 1,085 9,257 108,380 Lehigh/Capital MCOs 46,961 16,469 54,454 30,121 6,382 49,819 324,819


51 Gateway 4,259 3,812 3,102 2,618 73 2,693 29,512 52 United 2,669 533 868 474 32 4,678 15,563 53 Aetna 682 443 596 433 29 1,383 8,426 54 UPMC 2,111 499 782 471 40 1,470 10,045 57 AmeriHealth 8,840 1,354 5,883 4,953 27 3,355 50,738 Lehigh/Capital MCOs 18,561 6,641 11,231 8,949 201 13,579 114,284


51 Gateway 42 24 81 33 1 42 356 52 United 44 1 66 10 0 45 295 53 Aetna 19 4 37 17 0 48 249 54 UPMC 34 6 44 30 0 38 271 57 AmeriHealth 89 25 185 126 0 75 729 Lehigh/Capital MCOs 228 60 413 216 1 248 1,900

Unknown

51 Gateway 1,927 534 1,043 589 48 859 8,277 52 United 990 123 491 204 23 1,035 4,978 53 Aetna 315 105 291 199 16 545 3,734 54 UPMC 1,326 138 421 215 19 623 4,625 57 AmeriHealth 2,735 195 2,208 1,285 23 973 11,960 Lehigh/Capital MCOs 7,293 1,095 4,454 2,492 129 4,035 33,574

MCO TOTAL

51 Gateway 23,661 14,689 22,825 12,444 3,416 21,484 159,501 52 United 12,022 2,325 6,572 3,221 698 22,929 82,198 53 Aetna 4,273 2,276 4,268 3,083 918 10,051 60,682 54 UPMC 12,895 2,739 6,153 3,138 715 10,279 66,751 57 AmeriHealth 31,681 3,859 43,132 27,142 1,162 16,438 197,585

TOTAL 84,532 25,888 82,950 49,028 6,909 81,181 566,717



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


35 UPMC 14 158 139 443 52 5,344 7 36 Gateway 0 12 26 48 6 3,415 1 37 AmeriHealth 3 26 39 46 4 1,294 1 56 Aetna 1 21 32 33 6 2,785 3 Northwest MCOs 18 217 236 570 68 12,838 12


35 UPMC 1 7 18 36 12 131 4 36 Gateway 0 3 0 2 0 47 4 37 AmeriHealth 0 3 1 2 2 17 0 56 Aetna 0 2 2 0 1 39 0 Northwest MCOs 1 15 21 40 15 234 8

Asian

35 UPMC 7 15 38 42 13 1,339 1 36 Gateway 0 2 2 0 1 199 0 37 AmeriHealth 3 0 8 2 0 175 0 56 Aetna 0 2 3 2 3 151 0 Northwest MCOs 10 19 51 46 17 1,864 1

White

35 UPMC 814 4,440 10,227 12,036 3,817 25,116 595 36 Gateway 31 644 1,228 941 460 8,480 83 37 AmeriHealth 107 555 2,230 1,114 356 4,392 64 56 Aetna 57 575 1,913 1,140 357 6,742 49 Northwest MCOs 1,009 6,214 15,598 15,231 4,990 44,730 791


35 UPMC 9 50 94 142 26 1,975 4 36 Gateway 1 12 16 10 4 853 1 37 AmeriHealth 0 6 31 18 7 359 0 56 Aetna 1 9 33 24 0 629 1 Northwest MCOs 11 77 174 194 37 3,816 6



Unknown

35 UPMC 1 65 86 208 13 677 2 36 Gateway 0 5 10 14 0 207 0 37 AmeriHealth 0 9 25 17 6 115 0 56 Aetna 0 10 17 23 3 193 1 Northwest MCOs 1 89 138 262 22 1,192 3

MCO TOTAL

35 UPMC 846 4,738 10,608 12,909 3,936 34,623 613 36 Gateway 32 678 1,283 1,015 471 13,213 89 37 AmeriHealth 113 599 2,334 1,199 375 6,362 65 56 Aetna 59 619 2,000 1,222 371 10,553 54

TOTAL 1,050 6,634 16,225 16,345 5,153 64,751 821


15


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


35 UPMC 60 73 1,869 21 215 55 8,450 36 Gateway 10 3 664 2 37 16 4,240 37 AmeriHealth 7 14 478 15 28 10 1,965 56 Aetna 9 15 428 1 49 8 3,391 Northwest MCOs 86 105 3,439 39 329 89 18,046



Asian

35 UPMC 16 25 90 0 39 23 1,648 36 Gateway 4 1 20 0 2 1 232 37 AmeriHealth 2 9 17 2 4 2 224 56 Aetna 1 0 16 1 2 3 184 Northwest MCOs 23 35 143 3 47 29 2,288

White

35 UPMC 6,813 6,267 12,505 1,824 6,914 4,768 96,136 36 Gateway 837 245 2,767 53 721 710 17,200 37 AmeriHealth 374 1,264 1,758 1,207 986 808 15,215 56 Aetna 467 698 1,608 95 911 489 15,101 Northwest MCOs 8,491 8,474 18,638 3,179 9,532 6,775 143,652





Unknown


MCO TOTAL

35 UPMC 7,897 7,936 21,027 3,059 9,262 6,297 156,461 36 Gateway 863 253 3,574 57 788 743 23,059 37 AmeriHealth 394 1,303 2,381 1,262 1,048 838 18,273 56 Aetna 484 720 2,170 101 1,004 511 19,868

TOTAL 8,722 8,725 23,211 3,301 10,212 7,036 172,186


16


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


41 AmeriHealth NE 44 371 165 46 63 10 1,104 2,378 44 Geisinger 66 117 297 118 275 29 3,103 5,226 50 Aetna 57 78 190 58 96 13 919 1,659 Northeast MCOs 167 566 652 222 434 52 5,126 9,263


41 AmeriHealth NE 14 27 5 11 9 2 27 50 44 Geisinger 14 12 27 12 16 4 87 79 50 Aetna 8 6 5 0 3 3 29 16 Northeast MCOs 36 45 37 23 28 9 143 145

Asian

41 AmeriHealth NE 25 30 80 11 14 0 283 117 44 Geisinger 11 10 149 14 49 9 952 433 50 Aetna 9 10 90 0 20 3 199 108 Northeast MCOs 45 50 319 25 83 12 1,434 658

White

41 AmeriHealth NE 3,450 7,629 2,292 1,160 1,527 729 5,771 10,895 44 Geisinger 4,674 2,173 5,916 4,913 6,851 1,610 23,539 32,868 50 Aetna 3,217 975 2,262 755 1,142 616 4,200 6,044 Northeast MCOs 11,341 10,777 10,470 6,828 9,520 2,955 33,510 49,807


41 AmeriHealth NE 75 390 126 22 65 109 1,100 6,612 44 Geisinger 80 191 190 77 229 157 3,896 9,971 50 Aetna 45 79 140 23 68 54 803 1,547 Northeast MCOs 200 660 456 122 362 320 5,799 18,130



Unknown

41 AmeriHealth NE 84 244 80 16 44 36 620 775 44 Geisinger 95 81 133 61 122 43 2,073 1,614 50 Aetna 66 38 71 18 29 5 466 360 Northeast MCOs 245 363 284 95 195 84 3,159 2,749

MCO TOTAL 41 AmeriHealth NE 3,694 8,699 2,756 1,267 1,724 886 8,923 20,906 44 Geisinger 4,944 2,587 6,729 5,197 7,547 1,857 33,703 50,340 50 Aetna 3,406 1,189 2,769 854 1,365 694 6,636 9,767

TOTAL 12,044 12,475 12,254 7,318 10,636 3,437 49,262 81,013




Northeast cont.

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


41 AmeriHealth NE 932 75 3,036 21 290 378 506 25 44 Geisinger 2,291 119 2,384 43 557 347 573 107 50 Aetna 388 45 1,307 4 286 166 212 28 Northeast MCOs 3,611 239 6,727 68 1,133 891 1,291 160



Asian


White

41 AmeriHealth NE 4,226 2,096 9,884 356 3,264 2,104 8,850 1,120 44 Geisinger 12,988 4,540 7,255 1,504 10,676 4,483 12,825 3,222 50 Aetna 1,522 1,584 2,793 284 3,173 1,108 2,730 805 Northeast MCOs 18,736 8,220 19,932 2,144 17,113 7,695 24,405 5,147


41 AmeriHealth NE 110 45 2,765 19 231 394 903 40 44 Geisinger 276 77 2,088 68 513 451 834 108 50 Aetna 86 47 1,062 17 160 186 212 27 Northeast MCOs 472 169 5,915 104 904 1,031 1,949 175



Unknown

41 AmeriHealth NE 69 14 974 3 76 171 263 8 44 Geisinger 168 48 760 23 238 215 305 41 50 Aetna 42 21 384 3 87 93 89 12 Northeast MCOs 279 83 2,118 29 401 479 657 61

MCO TOTAL 41 AmeriHealth NE 5,368 2,238 17,022 402 3,894 3,118 10,636 1,221 44 Geisinger 15,833 4,821 12,826 1,663 12,092 5,617 14,661 3,492 50 Aetna 2,072 1,709 5,705 317 3,725 1,589 3,282 882

TOTAL 23,273 8,768 35,553 2,382 19,711 10,324 28,579 5,595


18


Northeast cont.

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


41 AmeriHealth NE 0 19 106 47 55 13 9,684 44 Geisinger 7 51 19 231 135 37 16,132 50 Aetna 7 23 22 67 30 9 5,664 Northeast MCOs 14 93 147 345 220 59 31,480


41 AmeriHealth NE 1 3 23 0 13 7 349 44 Geisinger 0 9 4 5 20 12 496 50 Aetna 1 2 2 4 13 2 166 Northeast MCOs 2 14 29 9 46 21 1,011

Asian

41 AmeriHealth NE 1 5 21 10 23 2 968 44 Geisinger 0 17 4 27 33 15 2,265 50 Aetna 0 2 1 2 6 1 640 Northeast MCOs 1 24 26 39 62 18 3,873

White

41 AmeriHealth NE 158 1,294 6,166 809 1,650 788 76,218 44 Geisinger 537 4,639 1,020 2,581 5,544 3,621 157,979 50 Aetna 148 1,008 603 632 1,201 566 37,368 Northeast MCOs 843 6,941 7,789 4,022 8,395 4,975 271,565




41 AmeriHealth NE 0 3 1 0 0 2 272 44 Geisinger 0 2 0 1 4 0 386 50 Aetna 0 0 0 0 5 0 140 Northeast MCOs 0 5 1 1 9 2 798

Unknown


MCO TOTAL 41 AmeriHealth NE 168 1,376 6,440 917 1,852 847 104,354 44 Geisinger 557 4,870 1,074 3,005 5,978 3,805 203,198 50 Aetna 160 1,076 655 717 1,342 598 50,509

TOTAL 885 7,322 8,169 4,639 9,172 5,250 358,061


19

Mandatory ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY November 2020

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 5 0 2 6 19 32 43 Aetna 5 5 3 13 17 43 45 Health Partners 7 2 2 10 29 50 47 Keystone 12 5 12 21 35 85 Southeast MCOs 29 12 19 50 100 210

Non-Hispanic

42 United 5,723 11,001 9,392 8,930 50,629 85,675 43 Aetna 7,872 7,035 10,774 10,998 36,735 73,414 45 Health Partners 12,341 3,246 9,514 10,972 143,670 179,743 47 Keystone 40,093 20,630 72,255 54,436 228,204 415,618 Southeast MCOs 66,029 41,912 101,935 85,336 459,238 754,450

Hispanic

42 United 757 3,756 593 1,378 7,700 14,184 43 Aetna 782 1,417 598 1,162 5,268 9,227 45 Health Partners 1,962 486 806 1,328 66,623 71,205 47 Keystone 5,153 4,871 4,609 7,790 31,713 54,136 Southeast MCOs 8,654 10,530 6,606 11,658 111,304 148,752

TOTAL 74,712 52,454 108,560 97,044 570,642 903,412




Southwest

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

Other/Unknown


Non-Hispanic

31 Gateway 57,973 1,092 10,584 731 5,502 4,667 3,531 3,808 32 United 23,121 703 2,745 1,145 3,396 1,396 5,027 8,758 34 UPMC 109,479 10,362 14,587 6,427 15,615 15,112 16,517 20,847 59 Aetna 10,331 509 1,497 687 2,156 1,088 2,779 922 Southwest MCOs 200,904 12,666 29,413 8,990 26,669 22,263 27,854 34,335

Hispanic

31 Gateway 1,054 10 156 4 97 89 76 29 32 United 583 11 99 16 55 38 159 60 34 UPMC 3,084 94 298 79 224 317 248 232 59 Aetna 278 7 61 7 40 26 68 26 Southwest MCOs 4,999 122 614 106 416 470 551 347

TOTAL 205,971 12,790 30,035 9,097 27,086 22,739 28,410 34,687


21


Southwest cont.

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

Other/Unknown

31 Gateway 0 1 0 0 0 4 29 32 United 0 0 0 0 3 2 24 34 UPMC 1 0 0 2 3 6 56 59 Aetna 0 0 0 0 1 1 11 Southwest MCOs 1 1 0 2 7 13 120

Non-Hispanic

31 Gateway 812 2,284 6,492 1,654 5,504 10,699 115,333 32 United 2,972 1,868 1,696 2,721 5,609 7,964 69,121 34 UPMC 3,736 9,614 9,500 7,308 21,133 34,759 294,996 59 Aetna 387 748 851 1,064 1,895 2,583 27,497 Southwest MCOs 7,907 14,514 18,539 12,747 34,141 56,005 506,947

Hispanic

31 Gateway 11 21 77 17 104 117 1,862 32 United 15 37 50 30 89 136 1,378 34 UPMC 25 118 287 80 377 471 5,934 59 Aetna 5 17 25 12 68 45 685 Southwest MCOs 56 193 439 139 638 769 9,859

TOTAL 7,964 14,708 18,978 12,888 34,786 56,787 516,926




Lehigh/Capital

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

Other/Unknown


Non-Hispanic

51 Gateway 3,667 7,950 11,249 21,570 1,268 190 441 52 United 3,964 6,098 4,161 9,670 2,090 396 700 53 Aetna 1,356 6,011 4,820 8,412 8,052 808 1,145 54 UPMC 1,365 7,633 3,927 8,132 718 561 3,540 57 AmeriHealth 1,429 16,315 5,246 5,915 10,449 708 1,709 Lehigh/Capital MCOs 11,781 44,007 29,403 53,699 22,577 2,663 7,535

Hispanic

51 Gateway 261 6,802 1,045 6,369 135 4 12 52 United 901 3,598 498 2,126 200 3 10 53 Aetna 173 2,581 319 1,336 766 9 13 54 UPMC 190 3,125 301 1,239 62 4 30 57 AmeriHealth 184 27,623 587 1,905 2,044 19 24 Lehigh/Capital MCOs 1,709 43,729 2,750 12,975 3,207 39 89

TOTAL 13,493 87,752 32,168 66,692 25,796 2,703 7,625


23


Lehigh/Capital cont.

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

Other/Unknown


Non-Hispanic

51 Gateway 18,433 9,072 10,495 8,153 3,329 18,383 114,200 52 United 8,667 1,574 3,646 2,537 662 17,135 61,300 53 Aetna 3,511 1,665 2,542 2,470 870 8,445 50,107 54 UPMC 10,447 1,992 4,117 2,463 692 8,612 54,199 57 AmeriHealth 20,265 1,947 20,685 18,998 1,136 12,115 116,917 Lehigh/Capital MCOs 61,323 16,250 41,485 34,621 6,689 64,690 396,723

Hispanic

51 Gateway 5,225 5,617 12,325 4,288 85 3,100 45,268 52 United 3,353 751 2,923 681 36 5,788 20,868 53 Aetna 760 610 1,724 610 47 1,605 10,553 54 UPMC 2,438 746 2,033 673 23 1,662 12,526 57 AmeriHealth 11,409 1,912 22,438 8,138 26 4,321 80,630 Lehigh/Capital MCOs 23,185 9,636 41,443 14,390 217 16,476 169,845

TOTAL 84,532 25,888 82,950 49,028 6,909 81,181 566,717




Northwest

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

Other/Unknown


Non-Hispanic

35 UPMC 826 4,703 10,507 12,744 3,890 32,217 604 36 Gateway 32 677 1,276 1,011 469 11,923 85 37 AmeriHealth 107 593 2,299 1,183 369 5,910 65 56 Aetna 58 605 1,972 1,206 367 9,642 53 Northwest MCOs 1,023 6,578 16,054 16,144 5,095 59,692 807

Hispanic

35 UPMC 20 34 101 165 46 2,403 9 36 Gateway 0 1 7 4 2 1,288 4 37 AmeriHealth 6 5 34 15 6 449 0 56 Aetna 1 14 28 13 4 910 1 Northwest MCOs 27 54 170 197 58 5,050 14

TOTAL 1,050 6,634 16,225 16,345 5,153 64,751 821


25


Northwest cont.

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

Other/Unknown


Non-Hispanic

35 UPMC 6,906 6,376 14,879 1,858 7,282 4,898 107,690 36 Gateway 858 252 3,530 55 769 737 21,674 37 AmeriHealth 392 1,290 2,340 1,251 1,033 829 17,661 56 Aetna 482 714 2,133 101 996 507 18,836 Northwest MCOs 8,638 8,632 22,882 3,265 10,080 6,971 165,861

Hispanic

35 UPMC 73 73 205 23 90 45 3,287 36 Gateway 5 1 43 2 18 6 1,381 37 AmeriHealth 2 13 38 11 15 9 603 56 Aetna 2 5 37 0 8 4 1,027 Northwest MCOs 82 92 323 36 131 64 6,298

TOTAL 8,722 8,725 23,211 3,301 10,212 7,036 172,186




Northeast

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

Other/Unknown


Non-Hispanic

41 AmeriHealth NE 3,640 7,846 2,656 1,229 1,644 768 7,194 12,952 44 Geisinger 4,864 2,339 6,560 5,096 7,223 1,681 27,725 37,764 50 Aetna 3,353 1,080 2,691 828 1,283 627 5,465 7,707 Northeast MCOs 11,857 11,265 11,907 7,153 10,150 3,076 40,384 58,423

Hispanic

41 AmeriHealth NE 54 849 99 38 80 116 1,728 7,952 44 Geisinger 79 248 162 101 324 175 5,970 12,569 50 Aetna 51 109 77 26 82 67 1,169 2,059 Northeast MCOs 184 1,206 338 165 486 358 8,867 22,580

TOTAL 12,044 12,475 12,254 7,318 10,636 3,437 49,262 81,013




Northeast cont.

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

Other/Unknown


Non-Hispanic

41 AmeriHealth NE 5,230 2,143 13,671 372 3,477 2,562 8,979 1,166 44 Geisinger 15,521 4,659 10,213 1,579 11,075 4,960 13,203 3,371 50 Aetna 1,995 1,606 4,437 307 3,429 1,332 2,940 858 Northeast MCOs 22,746 8,408 28,321 2,258 17,981 8,854 25,122 5,395

Hispanic

41 AmeriHealth NE 137 95 3,346 30 417 556 1,654 55 44 Geisinger 309 162 2,607 84 1,017 655 1,457 119 50 Aetna 76 103 1,265 10 295 257 341 24 Northeast MCOs 522 360 7,218 124 1,729 1,468 3,452 198

TOTAL 23,273 8,768 35,553 2,382 19,711 10,324 28,579 5,595




Northeast cont.

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

Other/Unknown

41 AmeriHealth NE 0 0 1 0 0 0 20 44 Geisinger 0 0 0 1 0 1 40 50 Aetna 0 2 0 0 1 0 15 Northeast MCOs 0 2 1 1 1 1 75

Non-Hispanic

41 AmeriHealth NE 168 1,336 6,368 848 1,744 826 86,819 44 Geisinger 543 4,755 1,068 2,766 5,728 3,721 176,414 50 Aetna 157 1,048 643 689 1,276 592 44,343 Northeast MCOs 868 7,139 8,079 4,303 8,748 5,139 307,576

Hispanic


TOTAL 885 7,322 8,169 4,639 9,172 5,250 358,061



Mandatory PLAN MAKE UP BY AGE GROUP AND GENDER November 2020

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs Female 22,485 18,399 59,575 124,944 225,403 Male 23,467 19,930 61,258 134,963 239,618 Total 45,952 38,329 120,833 259,907 465,021

22-45 Yrs Female 20,103 16,443 54,447 89,765 180,758 Male 18,037 15,990 33,880 53,387 121,294 Total 38,140 32,433 88,327 143,152 302,052


Over 64 Yrs Female 441 340 1,077 1,850 3,708 Male 294 242 695 1,183 2,414 Total 735 582 1,772 3,033 6,122

TOTAL 99,891 82,684 250,998 469,839 903,412

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL




Over 64 Yrs Female 128 73 398 33 632 Male 104 56 288 27 475 Total 232 129 686 60 1,107

TOTAL 117,224 70,523 300,986 28,193 516,926



LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs Female 44,691 21,923 14,641 16,446 53,561 151,262 Male 47,592 23,185 15,664 17,520 56,227 160,188 Total 92,283 45,108 30,305 33,966 109,788 311,450

22-45 Yrs Female 31,357 16,076 12,969 13,637 40,021 114,060 Male 15,880 10,334 9,272 9,473 20,673 65,632 Total 47,237 26,410 22,241 23,110 60,694 179,692

46-64 Yrs Female 11,137 5,610 4,040 4,974 15,444 41,205 Male 8,142 4,718 3,881 4,404 10,593 31,738 Total 19,279 10,328 7,921 9,378 26,037 72,943

Over 64 Yrs Female 448 222 133 171 711 1,685 Male 254 130 82 126 355 947 Total 702 352 215 297 1,066 2,632

TOTAL 159,501 82,198 60,682 66,751 197,585 566,717

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL




Over 64 Yrs Female 65 12 17 11 105 Male 54 9 15 16 94 Total 119 21 32 27 199

TOTAL 110,986 23,059 18,273 19,868 172,186



NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs Female 25,954 51,019 11,989 88,962

Male 27,371 54,098 12,798 94,267

Total 53,325 105,117 24,787 183,229

22-45 Yrs Female 21,576 41,211 10,507 73,294

Male 13,383 25,167 7,924 46,474

Total 34,959 66,378 18,431 119,768

46-64 Yrs Female 8,909 17,684 3,821 30,414

Male 6,861 13,467 3,363 23,691

Total 15,770 31,151 7,184 54,105

Over 64 Yrs Female 190 359 63 612

Male 110 193 44 347

Total 300 552 107 959

TOTAL 104,354 203,198 50,509 358,061


Mandatory PLAN MAKE UP BY AGE GROUP November 2020

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL < 21 Yrs 45,952 38,329 120,833 259,907 465,021 22-45 Yrs 38,140 32,433 88,327 143,152 302,052 46-64 Yrs 15,064 11,340 40,066 63,747 130,217 Over 64 Yrs 735 582 1,772 3,033 6,122

TOTAL 99,891 82,684 250,998 469,839 903,412 SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL < 21 Yrs 60,577 34,780 148,640 11,583 255,580 22-45 Yrs 38,694 24,718 101,003 12,153 176,568 46-64 Yrs 17,721 10,896 50,657 4,397 83,671 Over 64 Yrs 232 129 686 60 1,107

TOTAL 117,224 70,523 300,986 28,193 516,926 LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL < 21 Yrs 92,283 45,108 30,305 33,966 109,788 311,450 22-45 Yrs 47,237 26,410 22,241 23,110 60,694 179,692 46-64 Yrs 19,279 10,328 7,921 9,378 26,037 72,943 Over 64 Yrs 702 352 215 297 1,066 2,632

TOTAL 159,501 82,198 60,682 66,751 197,585 566,717


Mandatory PLAN MAKE UP BY AGE GROUP November 2020

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL < 21 Yrs 58,223 11,665 8,463 9,658 88,009 22-45 Yrs 35,842 7,990 6,721 7,367 57,920 46-64 Yrs 16,802 3,383 3,057 2,816 26,058 Over 64 Yrs 119 21 32 27 199

TOTAL 110,986 23,059 18,273 19,868 172,186 NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL < 21 Yrs 53,325 105,117 24,787 183,229 22-45 Yrs 34,959 66,378 18,431 119,768 46-64 Yrs 15,770 31,151 7,184 54,105 Over 64 Yrs 300 552 107 959

TOTAL 104,354 203,198 50,509 358,061


-

-

-

-

-

HealthChoices Enrollment AID CATEGORY DISTRIBUTION 4th Quarter 2019

TANF/HB/MAGI TANF/HB/MAGI Southeast (Ages 21+) Southwest (Ages 21+)

Lehigh/Capital TANF/HB/MAGI (Ages 21+)

3%

11%

TANF/HB/MAGI (Ages 1 20)

42%Disabled/BC&C 15%

Newly Eligible (45+) 9%

Newly Eligible (19-44)

20%

3%TANF/HB/MAGI Northwest (Ages 21+)

TANF/HB/MAGI Northeast

Under Age 1 3%

Source: Bureau of Fiscal Management 3% 3%

11%


40%

Under Age 1

Disabled/BC&C 14%



23%

11%


37%

Under Age 1

Disabled/BC&C 18%



22%

11%


39%

Under Age 1

Disabled/BC&C 18%



21%

(Ages 21+) 11%


39%

Under Age 1

Disabled/BC&C 15%



22%

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 November 2020

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.

November 2020

Zone Percentage

Southeast 92.6% Southwest 92.4% Lehigh/Capital 92.2% Northwest 93.6% Northeast 94.1% Total 92.7%

Source: Maximus

36

Medical Assistance Transportation Program

Based on Data Submitted by Each County

37

MATP 1Q FY 18/19

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips Mileage

Reimbursement Trips

Total Trips Client Utilization

Bucks $ 541,632 18,247 - 17,366 35,613 1.1%

Chester $ 570,936 11,205 3,181 5,940 20,326 1.6%

Delaware $ 1,259,087 22,144 5,192 5,262 32,598 0.8%

Montgomery $ 792,399 17,988 3,248 3,957 25,193 1.3%

Philadelphia $ 11,545,940 277,092 760,540 10,121 1,047,753 4.5%

HC-SE Zone $ 14,709,994 346,676 772,161 42,646 1,161,483 3.3%

38

Southwest

MATP 1Q FY 18/19


Reimbursement Trips


Allegheny $ 2,676,073 46,190 153,372 34,556 234,118 4.1%

Armstrong $ 417,494 8,121 - 4,712 12,833 4.8%

Beaver $ 669,140 14,237 283 14,016 28,536 3.3%

Bedford $ 144,152 4,074 - 3,753 7,827 4.0%

Blair $ 349,537 12,386 2,336 2,155 16,877 2.5%

Butler $ 563,232 10,953 - 4,437 15,390 2.6%

Cambria $ 1,024,987 30,238 3,884 4,258 38,380 5.7%

Fayette $ 386,008 16,055 9 21,058 37,122 3.1%

Greene $ 170,276 4,699 - 2,606 7,305 3.6%

Indiana $ 257,210 5,738 821 2,972 9,531 3.3%

Lawrence $ 308,891 7,926 2,918 10,239 21,083 3.2%

Somerset $ 389,998 8,376 - 4,882 13,258 3.9%

Washington $ 634,083 19,070 1,925 10,978 31,973 4.3%

Westmoreland $ 758,785 21,752 109 12,340 34,201 2.8%

HC-SW Zone $ 8,749,864 209,815 165,657 132,962 508,434 3.7%

39

Lehigh/Capital

MATP 1Q FY 18/19


Reimbursement Trips


Adams* $ 50,228 1,546 - 490 2,036 0.9%

Berks $ 804,600 18,874 9,881 4,818 33,573 2.3%

Cumberland $ 159,985 5,100 - 1,385 6,485 1.3%

Dauphin $ 751,035 24,659 5,084 1,172 30,915 2.7%

Franklin $ 128,161 3,873 - 1,322 5,195 1.2%

Fulton $ 106,947 1,485 - 1,084 2,569 6.4%

Huntingdon $ 185,951 3,021 - 5,014 8,035 5.1%

Lancaster $ 688,488 21,841 1,025 5,849 28,715 1.5%

Lebanon $ 447,081 17,874 98 1,188 19,160 1.9%

Lehigh $ 489,177 12,315 1,216 1,364 14,895 0.9%

Northampton $ 221,304 6,439 1,048 1,488 8,975 0.9%

Perry $ 68,361 2,404 - 367 2,771 1.8%

York* $ 274,034 7,793 478 2,837 11,108 0.7%

HC-L/C Zone $ 4,325,123 125,678 18,830 27,888 172,396 1.6%

* As of FY 17-18, the sole source contractor for Adams and York Counties were reported separate. Previously, they had combined reporting. 40

Northwest

MATP 1Q FY 18/19

COUNTY Total Expenditure Para Transit Trips

Mass Transit Trips

Mileage Reimbursement

Trips

Volunteer Trips Total Trips Client

Utilization

Cameron $ 61,150 779 50 271 - 1,100 4.6%

Clarion $ 174,753 2,251 - 2,143 - 4,394 4.2%

Clearfield $ 350,723 9,741 - 5,689 - 15,430 4.9%

Crawford $ 219,165 1,313 758 6,536 4,140 12,747 4.2%

Elk $ 210,755 2,826 1 1,030 - 3,857 4.6%

Erie $ 430,044 15,802 822 2,597 - 19,221 1.2%

Forest $ 42,919 620 - 370 - 990 4.8%

Jefferson $ 382,944 8,379 - 3,494 - 11,873 6.9%

McKean $ 161,287 2,109 14 1,002 - 3,125 3.0%

Mercer $ 242,537 9,924 - 1,705 - 11,629 2.8%

Potter $ 219,015 2,750 - 1,036 - 3,786 7.3%

Venango $ 274,226 4,733 23 1,184 - 5,940 3.5%

Warren $ 93,277 1,275 84 1,845 - 3,204 4.1%

HC-NW Zone $ 2,862,796 62,502 1,752 28,902 4,140 97,296 3.1%

41

Northeast

MATP 1Q FY 18/19

COUNTY Total Expenditure

Para Transit Trips

Mass Transit Trips

Mileage Reimbursement

Trips Total Trips Client Utilization

Bradford/Sullivan/Tioga $ 603,276 6,735 55 2,126 8,916 3.2%

Carbon $ 156,133 2,878 - 496 3,374 2.0%

Centre $ 169,620 4,034 301 1,502 5,837 1.8%

Clinton $ 206,090 3,961 - 514 4,475 4.3%

Columbia $ 108,055 3,349 - 1,031 4,380 2.0%

Juniata $ 32,555 640 - 576 1,216 1.0%

Lackawanna $ 294,207 7,746 2,767 1,909 12,422 1.0%

Luzerne $ 498,279 17,614 1,506 6,436 25,556 1.6%

Lycoming $ 378,213 9,021 1,420 2,048 12,489 3.5%

Mifflin $ 100,897 3,882 - 514 4,396 1.6%

Monroe $ 194,695 5,155 506 4,806 10,467 1.6%

Montour $ 43,888 1,225 - 554 1,779 3.1%

Northumberland $ 293,548 9,019 - 2,880 11,899 3.2%

Pike $ 71,505 1,227 - 1,643 2,870 1.1%

Schuylkill $ 422,504 6,998 379 2,457 9,834 2.2%

Snyder $ 61,724 1,346 - 1,156 2,502 2.4%

Susquehanna $ 151,567 2,475 - 1,642 4,117 3.7%

Union $ 31,627 1,028 - 254 1,282 1.7%

Wayne $ 155,843 3,846 - 1,480 5,326 3.6%

Wyoming $ 79,642 1,563 - 946 2,509 2.7%

HC-NE Zone $ 4,053,868 93,742 6,934 34,970 135,646 2.1%

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.

43

http://dhs.pa.gov/provider/healthcaremedicalassistance/managedcareinformation/

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