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What's Happening in PA?

In February 2015, Pennsylvania Governor Tom Wolf announced that Pennsylvania would transition to the HealthChoices program, the state’s Medical Assistance (or Medicaid) mandatory managed care program.

In February 2015, Pennsylvania Governor Tom Wolf announced that Pennsylvania would transition to the HealthChoices program, the state’s Medical Assistance (or Medicaid) mandatory managed care program.  Under the program, all existing and newly eligible beneficiaries were moved into a single benefit package for adults, effective September 30, 2015.  This transition mostly affected newly eligible adults between the ages of 21 to 64 in Pennsylvania with incomes up to 138 percent of the federal poverty level (FPL, $11,770 per year for an individual in 2015).

The HealthChoices program is administered by the Pennsylvania Department of Human Services (DHS) and has the following goals.

  • To improve access to health care services for Medical Assistance recipients;
  • To improve the quality of health care available to Medical Assistance recipients; and
  • To stabilize Pennsylvania's Medical Assistance spending.

Through Physical Health Managed Care Organizations, recipients receive medical care and access to all appropriate physical health services, whether the services are delivered on an inpatient or outpatient basis. The Department of Human Services Office of Medical Assistance Programs oversees the Physical Health component of the HealthChoices Program.

Through Behavioral Health Managed Care Organizations, recipients receive medical care and access to appropriate mental health and/or drug and alcohol services. This component is overseen by the Department of Human Services Office of Mental Health and Substance Abuse Services.

HealthChoices serves approximately 1,600,000 recipients in the following zones:

  • Southeast Zone - Bucks, Chester, Delaware, Montgomery and Philadelphia counties
  • Southwest Zone - Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Green, Indiana, Lawrence, Somerset, Washington and Westmoreland counties
  • Lehigh/Capital Zone - Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York counties
  • Northwest Zone - Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren counties
  • Northeast Zone - Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming counties

Pennsylvania uses the federal health insurance exchange rather than a state-run exchange. The Federally-Facilitated Marketplace (FFM) is the online option to buy health insurance for individuals and small businesses that provide insurance for their employees. Through the FFM, individuals and small businesses can compare health plans, get answers to questions, determine eligibility for lower out-of-pocket costs and enroll in health plans. Visit HealthCare.gov for more information.

Enrolling through the Federally-Facilitated Marketplace

Navigators are trained, nonbiased professionals who can explain the health care options on The Health Insurance Marketplace (healthcare.gov) and assist you with completing the eligibility and enrollment forms.

A listing of federally-funded organizations that can provide assistance with The Health Insurance Marketplace.

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What's Happening in PA?

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