MCO- UPMC Health Plan adds more than 11,000 Philadelphia-area Medicaid members

[MM Curator Summary]: The PA MCO continues to have success; this time in a new region (for Medicaid anyway- they already had a strong duals presence there).



A billboard used to promote UPMC Health Plan’s Medicaid managed care product, UPMC for You, in the Philadelphia region.

UPMC Health Plan

Medicaid managed care companies serving the five-county Philadelphia region have new competition from western Pennsylvania.

During this year’s open enrollment period, Pittsburgh-based UPMC Health Plan signed up 11,142 Medicaid recipients in Southeastern Pennsylvania for its UPMC for You plan, which will operate statewide as of Sept. 1.

John Lovelace, president of UPMC Health Plan, said that enrollment number will likely rise in the days ahead because the state will be randomly assigning — in an equitable manner — any Medicaid beneficiaries who did not enroll in a Physical HealthChoices program plan to a program participant.

“We’re starting off our big push forward with about 130,000 new people across Pennsylvania on Thursday, and maybe more,” Lovelace said.



UPMC Health Plan President John Lovelace

UPMC Health Plan

The Pennsylvania Department of Health, after a process delayed by litigation for several years, this year changed its lineup of health insurers participating in the state’s Physical HealthChoices program. The program requires recipients of Medicaid, which covers health care costs for low-income families and individuals, to enroll in a choice of managed care plans.

The state has separate Medicaid manage cared programs for mental health services, for children and for people dually eligible for Medicaid and Medicare — the federal and state program that covers health care costs of the elderly.

UPMC was selected as a Physical HealthChoices program participant in all five geographic zones in the state including Southeastern Pennsylvania, where it will compete with Independence Health Group’s Keystone First and Health Partners Plans, both of which are based in Philadelphia, along with United Healthcare and Geisinger Health Plans.

The biggest change locally is Aetna will no longer be part of the program.

The five-county region has 1 million people who qualify for the Physical HealthChoices program. The two Philadelphia-based companies lead the market, with Keystone having about 524,000 Medicaid members and Health Partners Plans having about 273,000.

New enrollment numbers for all the plans, following open enrollment, are not yet available.

UPMC Health Plan already has a presence in the Philadelphia region, Lovelace said, covering about 32,000 people who are either dually Medicare and Medicaid eligible or Medicare special needs patients.

Lovelace said the plan is in the process of expanded its Children’s Health Insurance Program (CHIP) coverage in the Philadelphia region.

Prior to expanding into Southeastern Pennsylvania as well as Northeastern Pennsylvania, where it has picked up about 20,715 Medicaid members, UPMC had about 560,000 Medicaid plan members throughout the rest of the state.

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