Thirteen health insurance plans have a May 2 deadline to apply to participate in a new managed care system transforming how 100,000 government-subsidized adults in southwestern Pennsylvania receive medical and long-term care services starting in 2017.
The Wolf administration issued a request for proposals Tuesday to the potential managed care organizations that would coordinate services for elderly and disabled individuals. Many of the possible MCOs are national, but local ones such as UPMC Health Plan and Gateway Health Plan are also among the 13 showing interest since spring in the state’s overhaul of services.
The program called Community HealthChoices — with a stated goal of delivering more home care services to subsidized consumers instead of costlier hospital and nursing home care — will ultimately affect more than 400,000 lower-income Pennsylvanians. That’s the number with disabilities or age-related frailty currently receiving health-related Medicaid services or services funded by both Medicaid and Medicare. The program is being phased in statewide over several years, starting Jan. 1 with 14 counties in the southwest region.
By fall, older or disabled adults already receiving subsidized services through the Pennsylvania Department of Aging or Department of Human Services are to be notified and assisted in choosing among several managed care organizations contracting with the state to coordinate services.
Anywhere from two to five MCOs will be offered to consumers in each region, according to the request for proposals. Each MCO will have a network of home care agencies, adult day care services, hospitals, doctors, dentists, therapists, nursing homes and more that they have arranged to provide services.
Secretary of Human Services Ted Dallas said Pennsylvania is following the path of at least 22 states before it in adopting such a system, in which an MCO service coordinator can more closely monitor each step of care received by a needy individual than is currently the case. The MCO will receive a fixed rate set in advance — known as capitation — for each individual’s care, which is supposed to encourage more preventive health measures and alternatives to institutional settings or revolving-door emergency room use.
“It will provide more options and more choices for people to live and remain in the community and continue about their lives as they age in place,” Mr. Dallas said in an interview Wednesday. “Right now we think the system is unbalanced and makes it far easier to be in a nursing home than served in the community.”
He said the potential MCOs have already been negotiating with providers of home and institutional services to form the networks, details of which will have to be spelled out in the request for proposal responses due in two months.
Gary Rotstein: grotstein@post-gazette.com or 412-263-1255.
First Published: March 3, 2016, 5:00 a.m.
