Monthly Physical Health Managed Care Program Enrollment ...

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.

BMCO

Monthly Physical Health Managed Care Program Enrollment Report

Released: October 29, 2018

Table of Contents

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

2

3

HealthChoices

Managed Care

Erie

Crawford

Mercer

Warren McKean Potter Tioga Bradford Susquehanna

Wayne

Pike

Lacka-wanna

Monroe

Luzerne

Wyoming

Carbon

Schuylkill

Columbia

Sullivan

Lycoming

Montour

North-umberland 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 September 2018 ENROLLMENT BY PLAN AND BY COUNTY

SOUTHEAST

County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

09 Bucks 5,624 6,885 12,119 40,105 64,733

15 Chester 12,844 7,161 2,639 22,278 44,922

23 Delaware 8,743 9,935 8,597 69,169 96,444

46 Montgomery 9,444 11,002 11,009 55,927 87,382

51 Philadelphia 54,610 35,499 213,906 248,850 552,865

TOTAL 91,265 70,482 248,270 436,329 846,346

PERCENTAGE 11% 8% 29% 52%

SOUTHWEST

County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

02 Allegheny 56,790 19,992 99,901 7,704 184,387

03 Armstrong 1,021 530 9,732 423 11,706

04 Beaver 10,749 2,244 13,256 1,261 27,510

05 Bedford 680 1,059 5,882 649 8,270

07 Blair 5,803 3,581 14,003 2,011 25,398

10 Butler 5,122 1,092 14,515 821 21,550

11 Cambria 3,588 5,001 15,141 2,668 26,398

26 Fayette 3,745 8,684 19,259 769 32,457

30 Greene 768 3,180 3,286 370 7,604

32 Indiana 2,310 1,637 8,703 562 13,212

37 Lawrence 6,644 1,454 8,780 741 17,619

56 Somerset 1,660 2,662 6,443 1,022 11,787

63 Washington 5,343 4,958 18,521 1,417 30,239

65 Westmoreland 10,828 7,498 31,530 1,964 51,820

TOTAL 115,051 63,572 268,952 22,382 469,957

PERCENTAGE 24% 14% 57% 5%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 10/11/18

5


cont. LEHIGH/CAPITAL

County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

01 Adams 4,001 4,559 1,241 1,243 1,475 12,519

06 Berks 14,737 7,874 6,608 8,405 41,310 78,934

21 Cumberland 11,769 3,657 4,071 1,935 5,015 26,447

22 Dauphin 27,188 10,419 7,837 5,030 6,394 56,868

28 Franklin 981 826 8,053 419 12,397 22,676

29 Fulton 151 280 793 526 688 2,438

31 Huntingdon 423 580 1,032 3,448 1,572 7,055

36 Lancaster 22,025 10,324 3,133 9,437 29,529 74,448

38 Lebanon 13,832 1,760 1,828 1,925 3,365 22,710

39 Lehigh 21,598 5,364 2,322 5,265 38,164 72,713

48 Northampton 12,463 2,771 2,104 2,567 24,180 44,085

50 Perry 3,508 659 660 353 1,033 6,213

67 York 20,946 21,390 7,670 7,101 14,867 71,974

TOTAL 153,622 70,463 47,352 47,654 179,989 499,080

PERCENTAGE 31% 14% 9% 10% 36%

NORTHWEST

County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

12 Cameron 826 35 109 38 1,008

16 Clarion 4,169 689 555 588 6,001

17 Clearfield 10,029 1,302 1,936 1,740 15,007

20 Crawford 12,057 901 1,018 1,096 15,072

24 Elk 3,424 390 301 265 4,380

25 Erie 32,543 13,612 5,839 9,706 61,700

27 Forest 522 89 75 53 739

33 Jefferson 6,511 838 327 341 8,017

42 McKean 6,187 263 1,194 657 8,301

43 Mercer 14,066 3,689 2,233 2,117 22,105

53 Potter 1,771 25 1,266 52 3,114

61 Venango 7,075 779 1,023 955 9,832

62 Warren 4,705 657 728 469 6,559

TOTAL 103,885 23,269 16,604 18,077 161,835

PERCENTAGE 64% 14% 10% 11%


6


cont.

NORTHEAST

County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

08 Bradford 2,900 4,519 3,411 10,830

13 Carbon 7,529 2,618 937 11,084

14 Centre 2,431 6,068 2,489 10,988

18 Clinton 1,145 4,953 778 6,876

19 Columbia 1,522 6,928 1,094 9,544

34 Juniata 820 1,747 648 3,215

35 Lackawanna 7,337 30,934 5,526 43,797

40 Luzerne 18,341 44,548 8,387 71,276

41 Lycoming 5,161 14,825 1,488 21,474

44 Mifflin 2,116 4,512 1,599 8,227

45 Monroe 14,848 12,126 4,985 31,959

47 Montour 335 1,555 301 2,191

49 Northumberland 3,123 10,612 3,509 17,244

52 Pike 2,751 5,109 1,323 9,183

54 Schuylkill 9,105 14,264 3,072 26,441

55 Snyder 1,164 2,970 848 4,982

57 Sullivan 144 458 140 742

58 Susquehanna 1,139 4,547 917 6,603

59 Tioga 5,841 943 545 7,329

60 Union 877 2,651 724 4,252

64 Wayne 1,631 5,638 1,161 8,430

66 Wyoming 726 3,325 558 4,609

TOTAL 90,986 185,850 44,440 321,276

PERCENTAGE 28% 59% 14%


7

Mandatory September 2018 MARKET SHARE BY PLAN – STATEWIDE

Total Enrollment = 2,298,494

AmeriHealth NE 90,986

4% Aetna

202,733 9%

AmeriHealth 196,593

8%

Gateway 291,942

13%

Health Partners 248,270

11%

Keystone 436,329

19%

United 225,300

10%

UPMC 420,491

18%

Geisinger 185,850

8%

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 10/11/18 8

Mandatory September 2018 MARKET SHARE BY ZONE AND BY PLAN

Northwest

Aetna 18,077

11%

Gateway 23,269

15%

UPMC 103,885

64%

Ameri-Health 16,604

10%

Southeast

Aetna 70,482

8%

Health Partners 248,270

29%

Keystone 436,329

52%

United 91,265

11%

Southwest Aetna 22,382

5%

Gateway 115,051

24%

United 63,572

14%

UPMC 268,952

57%

Lehigh/Capital

UPMC 47,654

10%

Aetna 47,352

9%

Ameri-Health

179,989 36%Gateway

153,622 31%

United 70,463

14%

Northeast

Aetna 44,440

14%

Ameri-Health NE

90,986 28%

Geisinger 185,850

58%


9

Mandatory September 2018 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY

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

Black or African American

42 United 644 2,465 4,562 2,224 34,152 44,047

43 Aetna 643 1,194 4,427 2,315 21,664 30,243

45 Health Partners 1,347 481 4,585 3,188 103,301 112,902

47 Keystone 4,151 3,841 33,358 12,876 151,657 205,883

Southeast MCOs 6,785 7,981 46,932 20,603 310,774 393,075

American Indian or Alaskan

Native

42 United 8 30 18 35 69 160

43 Aetna 20 44 14 47 66 191

45 Health Partners 33 8 17 36 257 351

47 Keystone 81 94 100 201 330 806

Southeast MCOs 142 176 149 319 722 1,508

Asian

42 United 265 288 496 493 3,678 5,220

43 Aetna 287 174 479 769 1,457 3,166

45 Health Partners 696 72 445 691 8,084 9,988

47 Keystone 1,369 655 4,388 3,742 19,369 29,523

Southeast MCOs 2,617 1,189 5,808 5,695 32,588 47,897

White

42 United 3,772 7,129 2,699 4,762 7,988 26,350

43 Aetna 4,893 4,469 4,014 6,081 6,656 26,113

45 Health Partners 7,748 1,579 2,415 5,099 34,019 50,860

47 Keystone 28,464 13,576 24,884 29,177 40,811 136,912

Southeast MCOs 44,877 26,753 34,012 45,119 89,474 240,235

Other or system default

42 United 622 2,075 616 1,328 6,769 11,410

43 Aetna 577 830 612 1,096 4,291 7,406

45 Health Partners 1,656 314 798 1,392 62,638 66,798

47 Keystone 4,360 3,036 4,548 7,377 30,122 49,443

Southeast MCOs 7,215 6,255 6,574 11,193 103,820 135,057

Native Hawaiian or Other

Pacific Islander

42 United 12 21 4 17 105 159

43 Aetna 22 11 20 24 54 131

45 Health Partners 19 2 12 19 249 301

47 Keystone 68 31 75 78 172 424

Southeast MCOs 121 65 111 138 580 1,015

Unknown

42 United 301 836 348 585 1,849 3,919

43 Aetna 443 439 369 670 1,311 3,232

45 Health Partners 620 183 325 584 5,358 7,070

47 Keystone 1,612 1,045 1,816 2,476 6,389 13,338

Southeast MCOs 2,976 2,503 2,858 4,315 14,907 27,559

MCO TOTAL

42 United 5,624 12,844 8,743 9,444 54,610 91,265

43 Aetna 6,885 7,161 9,935 11,002 35,499 70,482

45 Health Partners 12,119 2,639 8,597 11,009 213,906 248,270

47 Keystone 40,105 22,278 69,169 55,927 248,850 436,329

TOTAL 64,733 44,922 96,444 87,382 552,865 846,346

Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 10/11/18

10


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

Black or African

American

31 Gateway 27,601 26 2,541 19 433 223 499 384

32 United 8,163 24 447 13 256 31 908 818

34 UPMC 32,750 153 2,129 53 685 394 1,439 1,491

59 Aetna 2,797 6 255 9 120 23 723 79

Southwest MCOs 71,311 209 5,372 94 1,494 671 3,569 2,772

American Indian or

Alaskan Native

31 Gateway 125 1 17 0 6 5 6 4

32 United 44 1 4 1 10 1 4 14

34 UPMC 309 19 36 11 26 25 28 48

59 Aetna 24 0 7 3 3 0 3 5

Southwest MCOs 502 21 64 15 45 31 41 71

Asian

31 Gateway 734 2 31 0 10 22 6 12

32 United 453 2 27 3 25 15 13 20

34 UPMC 4,859 26 105 27 89 158 34 60

59 Aetna 189 0 9 3 9 9 13 3

Southwest MCOs 6,235 30 172 33 133 204 66 95

White

31 Gateway 25,172 979 7,882 649 5,254 4,725 2,959 3,277

32 United 9,784 488 1,646 1,020 3,214 966 3,907 7,651

34 UPMC 53,713 9,400 10,413 5,649 12,885 13,292 13,206 17,228

59 Aetna 3,816 409 913 621 1,841 731 1,839 643

Southwest MCOs 92,485 11,276 20,854 7,939 23,194 19,714 21,911 28,799

Other or system

default

31 Gateway 1,746 5 195 8 53 81 70 35

32 United 811 7 74 11 38 38 102 99

34 UPMC 4,436 65 324 102 155 310 245 189

59 Aetna 404 3 50 9 22 29 54 19

Southwest MCOs 7,397 80 643 130 268 458 471 342

Native Hawaiian or

Other Pacific Islander

31 Gateway 25 0 5 0 2 3 1 5

32 United 26 0 0 0 0 0 5 1

34 UPMC 110 2 12 3 4 5 6 14

59 Aetna 20 0 0 0 0 1 2 0

Southwest MCOs 181 2 17 3 6 9 14 20

Unknown

31 Gateway 1,387 8 78 4 45 63 47 28

32 United 711 8 46 11 38 41 62 81

34 UPMC 3,724 67 237 37 159 331 183 229

59 Aetna 454 5 27 4 16 28 34 20

Southwest MCOs 6,276 88 388 56 258 463 326 358

MCO TOTAL

31 Gateway 56,790 1,021 8,208 680 5,803 5,122 3,588 3,745

32 United 19,992 530 2,244 1,059 3,581 1,092 5,001 8,684

34 UPMC 99,901 9,732 13,256 5,882 14,003 14,515 15,141 19,259

59 Aetna 7,704 423 1,261 649 2,011 821 2,668 769

TOTAL 184,387 11,706 27,510 8,270 25,398 21,550 26,398 32,457


11


Southwest cont.

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

Black or African

American

31 Gateway 20 76 920 14 646 1,417 34,819

32 United 30 76 186 22 567 748 12,289

34 UPMC 41 240 884 63 1,664 2,175 44,161

59 Aetna 14 34 116 21 165 169 4,531

Southwest MCOs 105 426 2,106 120 3,042 4,509 95,800

American Indian or

Alaskan Native

31 Gateway 1 1 7 0 3 27 203

32 United 4 3 1 3 10 23 123

34 UPMC 5 22 17 7 37 48 638

59 Aetna 0 2 1 4 6 6 64

Southwest MCOs 10 28 26 14 56 104 1,028

Asian

31 Gateway 2 21 10 5 18 38 911

32 United 1 6 7 2 21 32 627

34 UPMC 12 54 44 23 128 254 5,873

59 Aetna 3 2 2 2 10 23 277

Southwest MCOs 18 83 63 32 177 347 7,688

White

31 Gateway 730 2,153 5,604 1,611 4,489 8,985 74,469

32 United 3,125 1,503 1,206 2,588 4,190 6,371 47,659

34 UPMC 3,168 8,140 7,607 6,200 15,925 27,645 204,471

59 Aetna 345 485 594 963 1,160 1,618 15,978

Southwest MCOs 7,368 12,281 15,011 11,362 25,764 44,619 342,577

Other or system

default

31 Gateway 13 28 55 23 89 177 2,578

32 United 14 23 41 27 82 144 1,511

34 UPMC 32 101 131 64 339 585 7,078

59 Aetna 5 23 17 10 29 69 743

Southwest MCOs 64 175 244 124 539 975 11,910

Native Hawaiian or


31 Gateway 0 1 0 1 1 1 45

32 United 0 0 0 1 2 2 37

34 UPMC 2 1 2 0 8 25 194

59 Aetna 0 0 0 0 1 1 25

Southwest MCOs 2 2 2 2 12 29 301

Unknown

31 Gateway 2 30 48 6 97 183 2,026

32 United 6 26 13 19 86 178 1,326

34 UPMC 26 145 95 86 420 798 6,537

59 Aetna 3 16 11 22 46 78 764

Southwest MCOs 37 217 167 133 649 1,237 10,653

MCO TOTAL

31 Gateway 768 2,310 6,644 1,660 5,343 10,828 115,051

32 United 3,180 1,637 1,454 2,662 4,958 7,498 63,572

34 UPMC 3,286 8,703 8,780 6,443 18,521 31,530 268,952

59 Aetna 370 562 741 1,022 1,417 1,964 22,382

TOTAL 7,604 13,212 17,619 11,787 30,239 51,820 469,957


12


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


51 Gateway 148 1,362 1,469 10,607 84 3 18

52 United 243 705 487 3,817 92 5 32

53 Aetna 66 796 404 2,451 641 18 48

54 UPMC 50 639 196 1,416 33 11 100

57 AmeriHealth 66 3,418 532 1,866 1,039 16 53

Lehigh/Capital MCOs 573 6,920 3,088 20,157 1,889 53 251

American Indian or

Alaskan Native

51 Gateway 21 20 35 66 7 1 0

52 United 13 19 12 28 3 0 1

53 Aetna 5 17 15 32 10 2 0

54 UPMC 3 17 4 14 2 1 0

57 AmeriHealth 2 54 11 22 37 4 2

Lehigh/Capital MCOs 44 127 77 162 59 8 3

Asian

51 Gateway 32 173 330 1,381 9 0 1

52 United 36 113 153 615 2 0 2

53 Aetna 12 110 121 365 43 1 5

54 UPMC 17 128 51 282 0 1 13

57 AmeriHealth 9 306 113 226 104 0 2

Lehigh/Capital MCOs 106 830 768 2,869 158 2 23

White

51 Gateway 3,451 6,945 8,095 8,361 748 145 391

52 United 3,560 4,241 2,298 3,583 611 270 535

53 Aetna 1,000 3,794 2,857 3,392 6,338 752 961

54 UPMC 1,031 5,174 1,331 2,215 337 512 3,262

57 AmeriHealth 1,210 14,271 3,558 2,542 9,031 649 1,485

Lehigh/Capital MCOs 10,252 34,425 18,139 20,093 17,065 2,328 6,634


51 Gateway 206 5,763 1,317 5,544 76 0 9

52 United 537 2,467 510 1,735 71 4 6

53 Aetna 97 1,575 392 1,104 610 13 13

54 UPMC 87 2,061 238 738 30 0 44

57 AmeriHealth 109 21,817 545 1,215 1,420 15 14

Lehigh/Capital MCOs 1,036 33,683 3,002 10,336 2,207 32 86


Pacific Islander

51 Gateway 2 13 14 29 1 0 0

52 United 9 23 10 13 1 0 0

53 Aetna 4 17 10 12 9 0 0

54 UPMC 2 18 5 11 0 0 1

57 AmeriHealth 6 61 4 16 17 0 3


Unknown

51 Gateway 141 461 509 1,200 56 2 4

52 United 161 306 187 628 46 1 4

53 Aetna 57 299 272 481 402 7 5

54 UPMC 53 368 110 354 17 1 28

57 AmeriHealth 73 1,383 252 507 749 4 13

Lehigh/Capital MCOs 485 2,817 1,330 3,170 1,270 15 54

MCO TOTAL

51 Gateway 4,001 14,737 11,769 27,188 981 151 423

52 United 4,559 7,874 3,657 10,419 826 280 580

53 Aetna 1,241 6,608 4,071 7,837 8,053 793 1,032

54 UPMC 1,243 8,405 1,935 5,030 419 526 3,448

57 AmeriHealth 1,475 41,310 5,015 6,394 12,397 688 1,572

TOTAL 12,519 78,934 26,447 56,868 22,676 2,438 7,055

Racial/Ethnic

information is self-

reported by consumers

Source: PA Department of Human Services Enterprise Data Warehouse – Updated 10/11/18 .

13


Lehigh/Capital cont.

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

Black or African

American

51 Gateway 1,858 564 2,991 1,786 39 2,400 23,329

52 United 1,261 106 847 393 9 3,881 11,878

53 Aetna 330 76 391 303 29 1,226 6,779

54 UPMC 963 120 756 268 11 1,010 5,573

57 AmeriHealth 3,296 153 4,485 2,641 20 2,266 19,851

Lehigh/Capital MCOs 7,708 1,019 9,470 5,391 108 10,783 67,410

American Indian or

Alaskan Native

51 Gateway 51 10 28 30 3 82 354

52 United 22 1 6 6 1 43 155

53 Aetna 13 6 7 10 4 55 176

54 UPMC 26 3 12 8 0 45 135

57 AmeriHealth 59 3 56 80 1 65 396

Lehigh/Capital MCOs 171 23 109 134 9 290 1,216

Asian

51 Gateway 833 109 321 195 7 213 3,604

52 United 286 22 120 71 2 248 1,670

53 Aetna 77 21 52 43 2 109 961

54 UPMC 397 19 160 55 1 67 1,191

57 AmeriHealth 704 66 641 501 1 171 2,844

Lehigh/Capital MCOs 2,297 237 1,294 865 13 808 10,270

White

51 Gateway 13,861 9,226 14,854 7,306 3,344 14,924 91,651

52 United 5,686 1,172 3,484 1,759 590 11,870 39,659

53 Aetna 2,020 1,239 1,462 1,348 589 4,914 30,666

54 UPMC 5,667 1,323 3,466 1,742 315 4,554 30,929

57 AmeriHealth 15,063 1,771 26,996 15,362 967 8,645 101,550



51 Gateway 4,128 3,488 2,785 2,759 76 2,633 28,784

52 United 2,445 362 610 368 31 4,526 13,672

53 Aetna 466 405 296 296 19 959 6,245

54 UPMC 1,546 363 589 339 16 983 7,034

57 AmeriHealth 8,461 1,178 4,754 4,716 25 2,929 47,198


Native Hawaiian or


51 Gateway 22 17 39 14 0 25 176

52 United 18 3 19 13 0 43 152

53 Aetna 5 1 5 7 0 15 85

54 UPMC 7 2 16 9 0 14 85

57 AmeriHealth 43 16 75 54 0 41 336


Unknown

51 Gateway 1,272 418 580 373 39 669 5,724

52 United 606 94 278 161 26 779 3,277

53 Aetna 222 80 109 97 17 392 2,440

54 UPMC 831 95 266 146 10 428 2,707

57 AmeriHealth 1,903 178 1,157 826 19 750 7,814

Lehigh/Capital MCOs 4,834 865 2,390 1,603 111 3,018 21,962

MCO TOTAL

51 Gateway 22,025 13,832 21,598 12,463 3,508 20,946 153,622

52 United 10,324 1,760 5,364 2,771 659 21,390 70,463

53 Aetna 3,133 1,828 2,322 2,104 660 7,670 47,352

54 UPMC 9,437 1,925 5,265 2,567 353 7,101 47,654

57 AmeriHealth 29,529 3,365 38,164 24,180 1,033 14,867 179,989

TOTAL 74,448 22,710 72,713 44,085 6,213 71,974 499,080

Racial/Ethnic

information is self-

reported by consumers.



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


35 UPMC 16 118 118 419 40 4,951 4

36 Gateway 0 13 28 38 6 3,491 1

37 AmeriHealth 6 27 27 32 5 1,236 0

56 Aetna 1 24 24 38 0 2,489 0

Northwest MCOs 23 182 197 527 51 12,167 5


Native

35 UPMC 2 3 9 33 13 110 3

36 Gateway 0 1 0 0 0 28 4

37 AmeriHealth 1 3 5 0 1 10 0

56 Aetna 0 0 0 1 1 41 1

Northwest MCOs 3 7 14 34 15 189 8

Asian

35 UPMC 7 16 51 47 7 1,387 1

36 Gateway 0 4 1 0 0 197 0

37 AmeriHealth 0 0 8 3 0 159 0

56 Aetna 0 3 5 1 1 112 0

Northwest MCOs 7 23 65 51 8 1,855 1

White

35 UPMC 788 3,932 9,713 11,341 3,325 23,926 513

36 Gateway 34 664 1,248 848 380 8,875 83

37 AmeriHealth 102 515 1,863 965 291 4,057 75

56 Aetna 37 553 1,683 1,029 257 6,378 49

Northwest MCOs 961 5,664 14,507 14,183 4,253 43,236 720


35 UPMC 9 38 60 88 18 1,712 1

36 Gateway 1 6 15 5 4 858 1

37 AmeriHealth 0 5 18 10 3 295 0

56 Aetna 0 2 17 11 3 552 3

Northwest MCOs 10 51 110 114 28 3,417 5


Pacific Islander

35 UPMC 0 4 4 2 1 27 0

36 Gateway 0 0 0 0 0 10 0

37 AmeriHealth 0 0 1 0 0 6 0

56 Aetna 0 1 0 1 1 10 0

Northwest MCOs 0 5 5 3 2 53 0

Unknown

35 UPMC 4 58 74 127 20 430 0

36 Gateway 0 1 10 10 0 153 0

37 AmeriHealth 0 5 14 8 1 76 0

56 Aetna 0 5 11 15 2 124 0

Northwest MCOs 4 69 109 160 23 783 0

MCO TOTAL

35 UPMC 1,059 6,080 15,372 15,461 4,510 62,544 782

36 Gateway 35 689 1,302 901 390 13,612 89

37 AmeriHealth 109 555 1,936 1,018 301 5,839 75

56 Aetna 38 588 1,740 1,096 265 9,706 53

TOTAL 1,008 6,001 15,007 15,072 4,380 61,700 739


15


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


35 UPMC 51 76 1,768 9 196 45 7,811

36 Gateway 6 5 698 0 28 10 4,324

37 AmeriHealth 3 11 464 20 30 11 1,872

56 Aetna 5 11 432 0 30 1 3,055

Northwest MCOs 65 103 3,362 29 284 67 17,062


Native

35 UPMC 5 16 26 2 18 15 255

36 Gateway 2 1 4 0 3 1 44

37 AmeriHealth 1 0 7 3 0 3 34

56 Aetna 0 5 1 0 4 3 57

Northwest MCOs 8 22 38 5 25 22 390

Asian

35 UPMC 16 20 94 1 26 8 1,681

36 Gateway 1 0 19 0 2 0 224

37 AmeriHealth 2 8 13 2 6 5 206

56 Aetna 1 1 14 0 1 1 140

Northwest MCOs 20 29 140 3 35 14 2,251

White

35 UPMC 6,374 5,997 11,766 1,730 6,734 4,588 90,727

36 Gateway 825 253 2,883 24 727 641 17,485

37 AmeriHealth 315 1,164 1,661 1,224 971 700 13,903

56 Aetna 330 635 1,597 51 894 457 13,950

Northwest MCOs 7,844 8,049 17,907 3,029 9,326 6,386 136,065


35 UPMC 31 45 215 10 54 30 2,311

36 Gateway 1 4 36 1 10 2 944

37 AmeriHealth 2 10 39 11 5 7 405

56 Aetna 3 5 33 0 15 4 648

Northwest MCOs 37 64 323 22 84 43 4,308


Pacific Islander

35 UPMC 1 3 9 1 3 2 57

36 Gateway 0 0 1 0 1 0 12

37 AmeriHealth 0 0 2 0 2 1 12

56 Aetna 0 0 1 0 2 0 16


Unknown

35 UPMC 33 30 188 18 44 17 1,043

36 Gateway 3 0 48 0 8 3 236

37 AmeriHealth 4 1 47 6 9 1 172

56 Aetna 2 0 39 1 9 3 211

Northwest MCOs 42 31 322 25 70 24 1,662

MCO TOTAL

35 UPMC 6,511 6,187 14,066 1,771 7,075 4,705 103,885

36 Gateway 838 263 3,689 25 779 657 23,269

37 AmeriHealth 327 1,194 2,233 1,266 1,023 728 16,604

56 Aetna 341 657 2,117 52 955 469 18,077

TOTAL 8,017 8,301 22,105 3,114 9,832 6,559 161,835


16


Northeast

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


41 AmeriHealth NE 48 263 103 26 78 11 853 2,084

44 Geisinger 66 103 252 97 227 21 2,554 4,547

50 Aetna 48 55 152 25 81 14 721 1,297

Northeast MCOs 162 421 507 148 386 46 4,128 7,928

American Indian or

Alaskan Native

41 AmeriHealth NE 7 18 8 2 2 1 23 25

44 Geisinger 7 7 14 3 10 1 70 58

50 Aetna 6 3 6 0 3 1 20 13

Northeast MCOs 20 28 28 5 15 3 113 96

Asian

41 AmeriHealth NE 17 19 69 8 16 4 209 117

44 Geisinger 16 18 138 16 42 9 959 395

50 Aetna 4 4 100 3 11 5 167 85

Northeast MCOs 37 41 307 27 69 18 1,335 597

White

41 AmeriHealth NE 2,748 6,797 2,099 1,080 1,363 690 4,929 10,118

44 Geisinger 4,343 2,325 5,442 4,714 6,431 1,561 22,453 30,436

50 Aetna 3,271 797 2,107 726 935 570 3,661 5,547

Northeast MCOs 10,362 9,919 9,648 6,520 8,729 2,821 31,043 46,101


41 AmeriHealth NE 36 296 86 15 45 91 1,042 5,594

44 Geisinger 39 113 102 60 129 137 3,864 8,215

50 Aetna 27 53 70 12 40 50 697 1,224

Northeast MCOs 102 462 258 87 214 278 5,603 15,033


Pacific Islander

41 AmeriHealth NE 0 1 3 2 1 0 8 27

44 Geisinger 1 0 8 1 5 0 22 42

50 Aetna 0 1 5 0 2 0 13 12

Northeast MCOs 1 2 16 3 8 0 43 81

Unknown

41 AmeriHealth NE 44 135 63 12 17 23 273 376

44 Geisinger 47 52 112 62 84 18 1,012 855

50 Aetna 55 24 49 12 22 8 247 209

Northeast MCOs 146 211 224 86 123 49 1,532 1,440

MCO TOTAL

41 AmeriHealth NE 2,900 7,529 2,431 1,145 1,522 820 7,337 18,341

44 Geisinger 4,519 2,618 6,068 4,953 6,928 1,747 30,934 44,548

50 Aetna 3,411 937 2,489 778 1,094 648 5,526 8,387

TOTAL 10,830 11,084 10,988 6,876 9,544 3,215 43,797 71,276

Racial/Ethnic information is self-reported by consumers.


17


Northeast cont.

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


41 AmeriHealth NE 928 50 2,526 12 159 368 392 34

44 Geisinger 2,161 105 2,203 47 415 351 547 100

50 Aetna 203 51 1,174 7 205 120 201 17

Northeast MCOs 3,292 206 5,903 66 779 839 1,140 151

American Indian or

Alaskan Native

41 AmeriHealth NE 10 4 38 1 10 13 19 1

44 Geisinger 32 5 50 2 12 26 20 3

50 Aetna 2 1 19 0 9 4 10 3

Northeast MCOs 44 10 107 3 31 43 49 7

Asian

41 AmeriHealth NE 17 7 180 5 10 24 47 19

44 Geisinger 70 18 197 22 50 47 71 9

50 Aetna 7 7 63 6 10 10 16 10

Northeast MCOs 94 32 440 33 70 81 134 38

White

41 AmeriHealth NE 4,056 1,990 8,863 296 2,672 1,938 7,872 1,064

44 Geisinger 12,380 4,344 7,201 1,441 9,522 4,210 12,873 2,755

50 Aetna 1,207 1,517 2,636 273 3,031 953 2,658 816

Northeast MCOs 17,643 7,851 18,700 2,010 15,225 7,101 23,403 4,635


41 AmeriHealth NE 83 35 2,487 13 193 306 619 27

44 Geisinger 204 64 2,078 35 453 361 675 75

50 Aetna 34 28 924 8 170 160 143 17

Northeast MCOs 321 127 5,489 56 816 827 1,437 119


Pacific Islander

41 AmeriHealth NE 4 0 47 0 2 12 6 1

44 Geisinger 5 3 27 2 7 8 9 2

50 Aetna 2 3 12 1 1 2 1 2

Northeast MCOs 11 6 86 3 10 22 16 5

Unknown

41 AmeriHealth NE 42 13 631 2 56 91 130 18

44 Geisinger 109 19 498 13 165 154 208 34

50 Aetna 20 8 255 4 47 51 45 16

Northeast MCOs 171 40 1,384 19 268 296 383 68

MCO TOTAL

41 AmeriHealth NE 5,140 2,099 14,772 329 3,102 2,752 9,085 1,164

44 Geisinger 14,961 4,558 12,254 1,562 10,624 5,157 14,403 2,978

50 Aetna 1,475 1,615 5,083 299 3,473 1,300 3,074 881

TOTAL 21,576 8,272 32,109 2,190 17,199 9,209 26,562 5,023



18


Northeast cont.

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


41 AmeriHealth NE 1 10 91 57 41 11 8,158

44 Geisinger 4 38 22 171 131 27 14,162

50 Aetna 7 17 15 50 35 8 4,487

Northeast MCOs 12 65 128 278 207 46 26,807

American Indian or

Alaskan Native

41 AmeriHealth NE 1 2 16 0 3 3 207

44 Geisinger 0 11 0 5 20 5 374

50 Aetna 1 1 1 1 6 3 116

Northeast MCOs 2 14 17 6 29 11 697

Asian

41 AmeriHealth NE 1 3 16 5 17 3 807

44 Geisinger 1 9 6 17 29 16 2,137

50 Aetna 0 1 1 2 5 1 516

Northeast MCOs 2 13 23 24 51 20 3,460

White

41 AmeriHealth NE 135 1,099 5,626 767 1,505 683 68,487

44 Geisinger 449 4,404 891 2,328 5,280 3,206 148,520

50 Aetna 131 876 509 649 1,052 538 34,419

Northeast MCOs 715 6,379 7,026 3,744 7,837 4,427 251,426


41 AmeriHealth NE 1 18 66 40 44 12 11,173

44 Geisinger 3 33 13 101 99 26 16,845

50 Aetna 0 14 13 17 44 5 3,739

Northeast MCOs 4 65 92 158 187 43 31,757


Pacific Islander

41 AmeriHealth NE 0 0 2 0 0 1 119

44 Geisinger 0 1 0 0 4 0 145

50 Aetna 0 0 0 0 1 0 56

Northeast MCOs 0 1 2 0 5 1 320

Unknown

41 AmeriHealth NE 5 7 24 8 21 13 2,035

44 Geisinger 1 51 11 29 75 45 3,667

50 Aetna 1 8 6 5 18 3 1,107

Northeast MCOs 7 66 41 42 114 61 6,809

MCO TOTAL

41 AmeriHealth NE 144 1,139 5,841 877 1,631 726 90,986

44 Geisinger 458 4,547 943 2,651 5,638 3,325 185,850

50 Aetna 140 917 545 724 1,161 558 44,440

TOTAL 742 6,603 7,329 4,252 8,430 4,609 321,276



19

Mandatory September 2018 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY

Southeast

09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast

Other/Unknown

42 United 14 13 7 24 75 133

43 Aetna 15 8 12 21 48 104

45 Health Partners 11 11 14 24 99 159

47 Keystone 35 14 32 64 145 290

Southeast MCOs 75 46 65 133 367 686

Non-Hispanic

42 United 5,007 9,569 8,234 8,118 47,898 78,826

43 Aetna 6,310 5,993 9,410 10,080 31,226 63,019

45 Health Partners 10,377 2,329 7,855 9,773 146,402 176,736

47 Keystone 35,589 18,013 65,233 49,337 220,121 388,293

Southeast MCOs 57,283 35,904 90,732 77,308 445,647 706,874

Hispanic

42 United 603 3,262 502 1,302 6,637 12,306

43 Aetna 560 1,160 513 901 4,225 7,359

45 Health Partners 1,731 299 728 1,212 67,405 71,375

47 Keystone 4,481 4,251 3,904 6,526 28,584 47,746

Southeast MCOs 7,375 8,972 5,647 9,941 106,851 138,786

TOTAL 64,733 44,922 96,444 87,382 552,865 846,346



20


Southwest

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

Other/Unknown

31 Gateway 40 0 2 0 2 6 1 0

32 United 23 1 2 0 1 1 2 3

34 UPMC 105 2 7 2 5 12 8 15

59 Aetna 22 0 1 1 0 0 1 0

Southwest MCOs 190 3 12 3 8 19 12 18

Non-Hispanic

31 Gateway 55,933 1,006 10,613 676 5,722 5,029 3,505 3,711

32 United 19,520 519 2,185 1,052 3,532 1,061 4,888 8,611

34 UPMC 97,369 9,656 13,060 5,810 13,818 14,224 14,968 19,050

59 Aetna 7,498 416 1,227 638 1,981 802 2,616 741

Southwest MCOs 180,320 11,597 27,085 8,176 25,053 21,116 25,977 32,113

Hispanic

31 Gateway 817 15 134 4 79 87 82 34

32 United 449 10 57 7 48 30 111 70

34 UPMC 2,427 74 189 70 180 279 165 194

59 Aetna 184 7 33 10 30 19 51 28

Southwest MCOs 3,877 106 413 91 337 415 409 326

TOTAL 184,387 11,706 27,510 8,270 25,398 21,550 26,398 32,457



21


Southwest cont.

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

Other/Unknown

31 Gateway 1 0 0 1 6 5 64

32 United 1 1 0 0 2 16 53

34 UPMC 2 3 1 4 9 24 199

59 Aetna 0 1 0 0 2 2 30

Southwest MCOs 4 5 1 5 19 47 346

Non-Hispanic

31 Gateway 763 2,286 6,589 1,647 5,256 10,708 113,444

32 United 3,162 1,607 1,421 2,633 4,890 7,370 62,451

34 UPMC 3,255 8,605 8,574 6,377 18,217 31,108 264,091

59 Aetna 368 536 729 1,008 1,379 1,925 21,864

Southwest MCOs 7,548 13,034 17,313 11,665 29,742 51,111 461,850

Hispanic

31 Gateway 4 24 55 12 81 115 1,543

32 United 17 29 33 29 66 112 1,068

34 UPMC 29 95 205 62 295 398 4,662

59 Aetna 2 25 12 14 36 37 488

Southwest MCOs 52 173 305 117 478 662 7,761

TOTAL 7,604 13,212 17,619 11,787 30,239 51,820 469,957



22


Lehigh/Capital

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

Other/Unknown

51 Gateway 2 9 9 9 1 0 0

52 United 3 7 5 19 0 0 0

53 Aetna 3 8 1 12 7 0 0

54 UPMC 0 6 2 6 2 1 1

57 AmeriHealth 1 13 6 6 9 0 0


Non-Hispanic

51 Gateway 3,712 7,934 10,884 21,147 898 147 415

52 United 3,681 5,030 3,273 8,564 771 278 572

53 Aetna 1,090 4,797 3,830 6,811 7,389 774 1,020

54 UPMC 1,105 5,970 1,791 4,329 394 523 3,403

57 AmeriHealth 1,313 15,754 4,561 4,960 10,458 671 1,558


Hispanic

51 Gateway 287 6,794 876 6,032 82 4 8

52 United 875 2,837 379 1,836 55 2 8

53 Aetna 148 1,803 240 1,014 657 19 12

54 UPMC 138 2,429 142 695 23 2 44

57 AmeriHealth 161 25,543 448 1,428 1,930 17 14

Lehigh/Capital MCOs 1,609 39,406 2,085 11,005 2,747 44 86

TOTAL 12,519 78,934 26,447 56,868 22,676 2,438 7,055



23


Lehigh/Capital cont.

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

Other/Unknown

51 Gateway 15 5 10 5 1 12 78

52 United 2 2 5 6 2 13 64

53 Aetna 3 2 4 5 0 5 50

54 UPMC 22 2 9 8 0 2 61

57 AmeriHealth 30 2 26 24 1 13 131


Non-Hispanic

51 Gateway 17,190 8,795 10,003 8,122 3,425 18,069 110,741

52 United 7,396 1,223 3,007 2,240 633 16,063 52,731

53 Aetna 2,591 1,304 1,419 1,705 640 6,540 39,910

54 UPMC 7,528 1,369 3,435 2,017 340 5,955 38,159

57 AmeriHealth 18,901 1,739 18,828 16,920 1,010 11,198 107,871


Hispanic

51 Gateway 4,820 5,032 11,585 4,336 82 2,865 42,803

52 United 2,926 535 2,352 525 24 5,314 17,668

53 Aetna 539 522 899 394 20 1,125 7,392

54 UPMC 1,887 554 1,821 542 13 1,144 9,434

57 AmeriHealth 10,598 1,624 19,310 7,236 22 3,656 71,987


TOTAL 74,448 22,710 72,713 44,085 6,213 71,974 499,080



24


Northwest

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

Other/Unknown

35 UPMC 0 4 3 5 0 13 0

36 Gateway 0 0 0 0 0 4 0

37 AmeriHealth 0 1 0 1 0 2 0

56 Aetna 0 0 0 3 0 3 0


Non-Hispanic

35 UPMC 800 4,127 9,958 11,920 3,384 30,474 521

36 Gateway 34 689 1,296 893 389 12,337 85

37 AmeriHealth 108 548 1,915 1,005 293 5,458 75

56 Aetna 37 576 1,715 1,078 259 8,923 52

Northwest MCOs 979 5,940 14,884 14,896 4,325 57,192 733

Hispanic

35 UPMC 26 38 68 132 40 2,056 1

36 Gateway 1 0 6 8 1 1,271 4

37 AmeriHealth 1 6 21 12 8 379 0

56 Aetna 1 12 25 15 6 780 1

Northwest MCOs 29 56 120 167 55 4,486 6

TOTAL 1,008 6,001 15,007 15,072 4,380 61,700 739



25


Northwest cont.

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

Other/Unknown

35 UPMC 4 0 16 3 3 2 53

36 Gateway 0 0 1 0 1 0 6

37 AmeriHealth 0 0 8 0 1 1 14

56 Aetna 0 0 0 0 1 0 7


Non-Hispanic

35 UPMC 6,431 6,115 13,874 1,754 7,000 4,673 101,031

36 Gateway 837 262 3,652 24 770 651 21,919

37 AmeriHealth 326 1,186 2,190 1,255 1,006 723 16,088

56 Aetna 337 655 2,099 51 943 465 17,190

Northwest MCOs 7,931 8,218 21,815 3,084 9,719 6,512 156,228

Hispanic

35 UPMC 76 72 176 14 72 30 2,801

36 Gateway 1 1 36 1 8 6 1,344

37 AmeriHealth 1 8 35 11 16 4 502

56 Aetna 4 2 18 1 11 4 880

Northwest MCOs 82 83 265 27 107 44 5,527

TOTAL 8,017 8,301 22,105 3,114 9,832 6,559 161,835



26


Northeast

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

Other/Unknown

41 AmeriHealth NE 4 3 4 1 1 1 7 7

44 Geisinger 4 3 13 1 0 1 25 21

50 Aetna 4 1 7 0 0 0 6 4

Northeast MCOs 12 7 24 2 1 2 38 32

Non-Hispanic

41 AmeriHealth NE 2,855 6,898 2,368 1,120 1,443 722 5,924 11,753

44 Geisinger 4,454 2,422 5,930 4,876 6,693 1,596 25,660 34,455

50 Aetna 3,377 870 2,417 758 1,018 582 4,557 6,809

Northeast MCOs 10,686 10,190 10,715 6,754 9,154 2,900 36,141 53,017

Hispanic

41 AmeriHealth NE 41 628 59 24 78 97 1,406 6,581

44 Geisinger 61 193 125 76 235 150 5,249 10,072

50 Aetna 30 66 65 20 76 66 963 1,574

Northeast MCOs 132 887 249 120 389 313 7,618 18,227

TOTAL 10,830 11,084 10,988 6,876 9,544 3,215 43,797 71,276




Northeast cont.

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

Other/Unknown

41 AmeriHealth NE 3 2 8 0 1 0 1 0

44 Geisinger 6 0 13 0 1 13 5 3

50 Aetna 1 0 8 0 2 1 1 2

Northeast MCOs 10 2 29 0 4 14 7 5

Non-Hispanic

41 AmeriHealth NE 5,048 2,028 11,969 314 2,804 2,296 7,975 1,119

44 Geisinger 14,559 4,377 9,751 1,501 9,819 4,516 13,040 2,854

50 Aetna 1,459 1,532 3,874 294 3,235 1,101 2,807 819

Northeast MCOs 21,066 7,937 25,594 2,109 15,858 7,913 23,822 4,792

Hispanic

41 AmeriHealth NE 110 86 2,871 21 318 455 1,129 45

44 Geisinger 260 135 2,362 54 792 580 1,219 113

50 Aetna 28 67 1,103 7 272 221 264 27

Northeast MCOs 398 288 6,336 82 1,382 1,256 2,612 185

TOTAL 21,474 8,227 31,959 2,191 17,244 9,183 26,441 4,982



28


Northeast cont.

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

Other/Unknown

41 AmeriHealth NE 0 0 1 0 1 0 45

44 Geisinger 0 1 0 4 1 5 120

50 Aetna 0 1 0 0 1 0 39

Northeast MCOs 0 2 1 4 3 5 204

Non-Hispanic

41 AmeriHealth NE 139 1,126 5,774 800 1,515 713 76,703

44 Geisinger 445 4,452 936 2,435 5,415 3,242 163,428

50 Aetna 138 901 539 688 1,098 551 39,424

Northeast MCOs 722 6,479 7,249 3,923 8,028 4,506 279,555

Hispanic

41 AmeriHealth NE 5 13 66 77 115 13 14,238

44 Geisinger 13 94 7 212 222 78 22,302

50 Aetna 2 15 6 36 62 7 4,977

Northeast MCOs 20 122 79 325 399 98 41,517

TOTAL 742 6,603 7,329 4,252 8,430 4,609 321,276



29

Mandatory September 2018 PLAN MAKE UP BY AGE GROUP AND GENDER

SOUTHEAST

42 United 43 Aetna 45 Health

Partners 47 Keystone TOTAL

< 21 Yrs

Female 21,628 16,801 59,311 116,630 214,370 Male 22,562 18,255 60,454 125,788 227,059 Total 44,190 35,056 119,765 242,418 441,429

22-45 Yrs


46-64 Yrs


Over 64 Yrs

Female 406 283 1,041 1,617 3,347 Male 280 184 586 986 2,036 Total 686 467 1,627 2,603 5,383

TOTAL 91,265 70,482 248,270 436,329 846,346

SOUTHWEST

31 Gateway 32 United 34 UPMC 59 Aetna TOTAL

< 21 Yrs


22-45 Yrs


46-64 Yrs


Over 64 Yrs

Female 134 55 378 28 595 Male 69 44 262 18 393 Total 203 99 640 46 988

TOTAL 115,051 63,572 268,952 22,382 469,957


30


LEHIGH/CAPITAL

57 51 Gateway 52 United 53 Aetna 54 UPMC TOTAL

AmeriHealth

Female 43,863 19,535 11,660 11,990 49,827 136,875

< 21 Yrs Male 46,464 20,616 12,493 13,055 52,260 144,888

Total 90,327 40,151 24,153 25,045 102,087 281,763

Female 29,693 13,202 9,815 9,577 36,076 98,363

22-45 Yrs Male 14,057 7,950 6,801 6,209 17,217 52,234

Total 43,750 21,152 16,616 15,786 53,293 150,597

Female 11,055 4,819 3,310 3,570 14,241 36,995

46-64 Yrs Male 7,838 4,057 3,104 3,045 9,513 27,557

Total 18,893 8,876 6,414 6,615 23,754 64,552

Female 425 178 107 122 575 1,407

Over 64 Yrs Male 227 106 62 86 280 761

Total 652 284 169 208 855 2,168

TOTAL 153,622 70,463 47,352 47,654 179,989 499,080

NORTHWEST

Female

< 21 Yrs Male

Total

Female

22-45 Yrs Male

Total

Female

46-64 Yrs Male

Total

Female

Over 64 Yrs Male

Total


26,597 5,921 3,759 4,496 40,773

28,193 6,148 3,983 4,625 42,949

54,790 12,069 7,742 9,121 83,722

20,605 4,680 3,393 3,556 32,234

12,143 3,076 2,594 2,711 20,524

32,748 7,756 5,987 6,267 52,758

9,423 1,838 1,438 1,439 14,138

6,803 1,582 1,412 1,225 11,022

16,226 3,420 2,850 2,664 25,160

61 15 15 10 101

60 9 10 15 94

121 24 25 25 195

TOTAL 103,885 23,269 16,604 18,077 161,835


31


NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs

Female 23,180 47,458 10,969 81,607

Male 24,220 50,161 11,694 86,075

Total 47,400 97,619 22,663 167,682

22-45 Yrs

Female 18,649 37,458 8,891 64,998

Male 10,829 21,261 6,464 38,554

Total 29,478 58,719 15,355 103,552

46-64 Yrs

Female 7,894 16,723 3,432 28,049

Male 5,933 12,296 2,895 21,124

Total 13,827 29,019 6,327 49,173

Over 64 Yrs

Female 192 318 59 569

Male 89 175 36 300

Total 281 493 95 869

TOTAL 90,986 185,850 44,440 321,276


Mandatory September 2018 PLAN MAKE UP BY AGE GROUP

SOUTHEAST

42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL

< 21 Yrs 44,190 35,056 119,765 242,418 441,429

22-45 Yrs 32,011 25,429 82,620 127,431 267,491

46-64 Yrs 14,378 9,530 44,258 63,877 132,043

Over 64 Yrs 686 467 1,627 2,603 5,383

TOTAL 91,265 70,482 248,270 436,329 846,346

SOUTHWEST


< 21 Yrs 61,503 33,274 133,414 9,509 237,700

22-45 Yrs 35,884 20,684 88,003 9,086 153,657

46-64 Yrs 17,461 9,515 46,895 3,741 77,612

Over 64 Yrs 203 99 640 46 988

TOTAL 115,051 63,572 268,952 22,382 469,957

LEHIGH/CAPITAL

51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL

< 21 Yrs 90,327 40,151 24,153 25,045 102,087 281,763

22-45 Yrs 43,750 21,152 16,616 15,786 53,293 150,597

46-64 Yrs 18,893 8,876 6,414 6,615 23,754 64,552

Over 64 Yrs 652 284 169 208 855 2,168

TOTAL 153,622 70,463 47,352 47,654 179,989 499,080


33

Mandatory September 2018 PLAN MAKE UP BY AGE GROUP

NORTHWEST

35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL

< 21 Yrs 54,790 12,069 7,742 9,121 83,722

22-45 Yrs 32,748 7,756 5,987 6,267 52,758

46-64 Yrs 16,226 3,420 2,850 2,664 25,160

Over 64 Yrs 121 24 25 25 195

TOTAL 103,885 23,269 16,604 18,077 161,835

NORTHEAST

41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL

< 21 Yrs 47,400 97,619 22,663 167,682

22-45 Yrs 29,478 58,719 15,355 103,552

46-64 Yrs 13,827 29,019 6,327 49,173

Over 64 Yrs 281 493 95 869

TOTAL 90,986 185,850 44,440 321,276


34

HealthChoices Enrollment 4th Quarter 2017 AID CATEGORY DISTRIBUTION

Southeast

Newly Eligible (45+) 10%

Newly Eligible (19-44)

23%

SSI & HH 16%

TANF/HB/MAGI (Ages 0-20)

42%

B&CC <1% TANF/HB/MAGI

(Ages 21+) 10%

Northwest


22%

SSI & HH 17%


41%

B&CC <1%

TANF/HB/MAGI (Ages 21+)

10%


Southwest B&CC <1%


11%


22%

Newly Eligible (45+) 10%SSI & HH

18%


39% Lehigh/Capital B&CC

<1%



21%

SSI & HH 15%


45%


10%

Northeast B&CC <1% TANF/HB/MAGI

(Ages 21+) 11%

35


22%

Newly Eligible(45+) 10%

SSI & HH 14%


42%

Source: Division of Financial Analysis

New Categories of Aid: TANF/HB/MAGI is Temporary Assistance for Needy Families, Healthy Beginnings, and Modified Adjusted Gross Income.

HealthChoices Enrollment September 2018 PCP SELECTION

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.

September 2018

Zone Percentage

Southeast 92.9%

Southwest 93.6%

Lehigh/Capital 93.9%

Northwest 94.3%

Northeast 93.7%

Total 93.5%

Source: Maximus

36

37

Medical Assistance Transportation Program

Based on Data Submitted by Each County

MATP 4Q FY 16/17

Southeast

COUNTY Total Expenditure Para Transit Trips Mass Transit Trips

Mileage

Reimbursement

Trips

Total Trips Client Utilization

Bucks $ 611,076 19,835 - 16,208 36,043 2.6%

Chester $ 635,252 13,159 4,102 4,788 22,049 4.2%

Delaware $ 1,220,906 25,521 3,749 5,232 34,502 1.7%

Montgomery $ 881,681 20,253 2,930 6,553 29,736 2.1%

Philadelphia $ 10,834,539 271,955 834,697 13,474 1,120,126 3.5%

HC-SE Zone $ 14,183,454 350,723 845,478 46,255 1,242,456 3.1%

38

MATP 4Q FY 16/17

Southwest


Mileage

Reimbursement

Trips


Allegheny $ 2,698,984 43,726 179,766 45,010 268,502 6.7%

Armstrong $ 417,075 9,757 - 4,828 14,585 8.0%

Beaver $ 555,070 12,858 301 22,108 35,267 4.8%

Bedford $ 137,494 3,733 - 5,284 9,017 6.9%

Blair $ 306,549 10,005 4,633 2,155 16,793 4.7%

Butler $ 709,154 14,537 - 5,535 20,072 6.1%

Cambria $ 1,014,211 28,909 6,373 7,270 42,552 8.8%

Fayette $ 426,920 13,351 25 20,285 33,661 4.6%

Greene $ 178,031 4,902 - 1,824 6,726 5.5%

Indiana $ 267,342 6,411 720 5,648 12,779 5.9%

Lawrence $ 274,278 7,240 2,748 13,260 23,248 6.1%

Somerset $ 311,150 6,194 - 7,353 13,547 6.1%

Washington $ 664,887 18,428 1,957 13,087 33,472 6.4%

Westmoreland $ 727,440 21,875 123 16,725 38,723 4.3%

HC-SW Zone $ 8,688,585 201,926 196,646 170,372 568,944 6.1%

39

MATP 4Q FY 16/17

Lehigh/Capital


Mileage

Reimbursement

Trips


Berks $ 576,458 17,060 11,012 4,908 32,980 4.9%

Cumberland $ 133,664 4,320 48 2,197 6,565 2.0%

Dauphin $ 775,320 25,567 6,231 2,090 33,888 5.4%

Franklin $ 98,120 2,974 - 1,812 4,786 1.9%

Fulton $ 102,682 1,527 - 1,412 2,939 11.5%

Huntingdon $ 179,182 3,274 - 7,063 10,337 8.4%

Lancaster $ 645,910 20,645 729 5,799 27,173 2.7%

Lebanon $ 363,331 16,754 426 998 18,178 4.2%

Lehigh $ 450,924 15,417 3,744 2,448 21,609 1.7%

Northampton $ 181,808 3,264 5,944 2,220 11,428 1.7%

Perry $ 63,232 2,337 - 746 3,083 3.4%

York/Adams $ 307,937 8,921 514 5,579 15,014 1.3%

HC-L/C Zone $ 3,878,568 122,060 28,648 37,272 187,980 3.1%

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MATP 4Q FY 16/17

Northwest

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Cameron $ 77,633 1,050 125 189 1,364 4.8%

Clarion $ 157,145 2,443 - 2,118 4,561 5.7%

Clearfield $ 314,922 9,228 - 6,828 16,056 6.3%

Crawford $ 294,094 1,663 834 18,247 20,744 7.7%

Elk $ 220,445 3,088 - 789 3,877 5.6%

Erie $ 446,425 17,718 724 3,341 21,783 2.3%

Forest $ 40,237 750 - 174 924 5.0%

Jefferson $ 455,067 9,539 8 4,444 13,991 11.0%

McKean $ 183,832 2,402 36 792 3,230 3.6%

Mercer $ 241,852 9,357 - 2,161 11,518 4.1%

Potter $ 203,464 2,283 - 1,108 3,391 10.4%

Venango $ 245,607 4,269 65 2,173 6,507 5.2%

Warren $ 68,823 1,339 56 2,270 3,665 6.6%

HC-Northwest Zone $ 2,949,546 65,129 1,848 44,634 111,611 4.8%

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MATP 4Q FY 16/17

Northeast

COUNTY Total

Expenditure

Para Transit

Trips

Mass Transit

Trips

Mileage

Reimbursement

Trips


Bradford/Tioga $ 406,750 6,463 274 1,768 8,505 4.6%

Carbon $ 119,323 2,517 - 1,026 3,543 4.7%

Centre $ 132,339 4,134 145 1,563 5,842 4.4%

Clinton $ 228,222 3,726 - 764 4,490 6.8%

Columbia $ 108,231 2,252 - 3,025 5,277 2.9%

Juniata $ 22,099 626 - 170 796 2.2%

Lackawanna $ 168,637 6,876 2,862 1,745 11,483 1.6%

Luzerne $ 318,648 15,666 958 7,217 23,841 2.6%

Lycoming $ 426,782 9,634 2,742 4,007 16,383 6.8%

Mifflin $ 125,164 3,770 - 1,448 5,218 3.9%

Monroe $ 223,570 5,916 760 5,371 12,047 2.6%

Montour $ 47,399 1,171 - 1,140 2,311 5.2%

Northumberland $ 239,147 7,773 - 3,887 11,660 5.0%

Pike $ 59,675 1,461 - 1,930 3,391 3.2%

Schuylkill $ 254,662 5,404 1,107 3,010 9,521 3.1%

Snyder $ 47,891 1,167 - 1,168 2,335 3.8%

Sullivan $ 24,806 253 40 58 351 4.7%

Susquehanna $ 142,043 2,525 - 1,534 4,059 5.4%

Union $ 34,908 1,083 - 619 1,702 3.7%

Wayne $ 188,121 3,958 - 1,397 5,355 5.8%

Wyoming $ 72,654 1,939 - 476 2,415 3.5%

HC-Northeast Zone $ 3,391,070 88,314 8,888 43,323 140,525 3.5%

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.

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