Why is HealthChoices Delayed?

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

As many may know by now, the Department of Human Services recently announced they would delay and stagger the implementation of the new HealthChoices contracts. This was due to several bid protests and court battles currently working its way through the system.

This pushes the implementation to January of 2018.  The current plan is to rollout the new HealthChoices contracts:

January 2018                Southwest & Northwest

March 2018                   Northeast

July 2018                       Southeast

January 2019                Lehigh/Capitol

This will make the staggered roll-out similar to the Community HealthChoices implementation plan.

But why the delay?

Simply put, there are billions of dollars at stake.  The total funds available for HealthChoices are  estimated to be over $12 billion. So those organizations that do not win bids miss out on one of the largest state contracts in the US.

Number of Regions in Old Contract Number of Regions in New Contract
Centene 3 3
Health Partners 1 2
United 5 0
UPMC for You 5 4
Keystone 1 1
Gateway 2 5
Aetna 1 0
AmeriHealth 3 2

This could also be one of the reasons why DHS is staggering the roll out. With the staggered roll out the Lehigh Capitol region transitions in January of 2019. This means that United and Amerihealth will get to keep their consumers for almost two years longer than originally anticipated.

We are still expecting court challenges which could delay the implementation further.

For your reference, I have included charts which details what MCOs were awarded what regions and the number of regions they were awarded.

GAO continues to monitor this situation and will update the pediatric leadership as more information becomes available.

 

 

 

 

 

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