Half a million Pennsylvanians who are enrolled in Medicaid will have to select a new health plan by August 16.
The changes come as a result of new agreements between the state of Pennsylvania and managed care organizations, which disburse Medicaid funds to health care providers. It’s the first time new agreements have rolled out in several years.
Some plans will no longer be available once those new agreements take effect in September, and people enrolled in those plans will have to choose a new one.
Medicaid, also known in Pennsylvania as Medical Assistance, is a program jointly funded by the state and federal governments. It provides health care coverage to low-income and disabled individuals.
More than 3.5 million Pennsylvanians are enrolled in the system statewide. That number has grown over the past few years, due in part to the economic toll of the COVID-19 pandemic, and in part to federal rule changes that have made it easier for people to stay covered in the program.
State human services officials said that Medicaid recipients should have gotten information in the mail about whether their current plan will continue to be available. All Medicaid enrollees will have the option to change health care plans if they wish.
“This can be a confusing process for a lot of folks. Don’t wait, get help early,” said Patrick Keenan, director of policy and partnerships for advocacy group Pennsylvania Health Access Network. Roughly half of the people impacted by the change are children, he said.
State officials, advocates and insurers are encouraging consumers to be proactive about examining the available plans, so they can select one in which their doctors are covered.
“I strongly encourage all Medicaid recipients to review their options, look for plans that include doctors you use and hospitals in your area, and choose a plan that best meets your individual needs before August 16,” Meg Snead, Pennsylvania Department of Human Services acting secretary, said in a statement announcing the changes.
“[T]hey have choices. And it's important for them to make an active selection,” said Ellen Duffield, CEO of Highmark Wholecare.
No one will lose coverage in the transition, officials said, though if people do not select a new plan and their current plan is being discontinued, they will automatically be enrolled in a new one.
“I think this will be a fairly, relatively painless process for people,” said John Lovelace, president of government programs for UPMC Health Plan.
Medicaid consumers can choose a new plan in several ways: Online at enrollnow.net; via the PA Enrollment Services mobile app; or by calling 1-800-440-3989 Monday through Friday, 8 a.m. to 6 p.m. Select Option 6 to speak with a representative.