September 15, 2022

Pennsylvania: Medicaid/HealthChoices agreement changes

Important information for your patients enrolled in Medicaid

Effective Sept. 1, 2022, there were some changes to the Managed Care Organizations (MCOs) serving Medicaid/HealthChoices members in Pennsylvania. As a result, some Medicaid beneficiaries need to change MCOs. We want to share important information with you about these changes.

What you need to know

Medicaid members are not losing access to Medicaid or their benefits – they’re only changing Managed Care Organizations (MCOs)/insurers. Additionally, the Medicaid/HealthChoices agreement changes do not impact Children’s Health Insurance Program (CHIP) or Dual Special Needs (DSNP) members. 

UnitedHealthcare Community Plan of Pennsylvania will continue to cover CHIP and DSNP members with no changes to these members’ benefit plans. Network health care professionals should continue serving CHIP and DSNP members in the same manner they do today.

Additional details

  • Network health care professionals should continue serving these members and working with the members’ new MCO after Sept. 1, 2022, especially to continue an existing course of treatment
  • MCOs that are receiving transferring members are required to honor existing prior authorizations from the previous insurer/MCO
  • Network health care professionals should work with the members’ new MCO to set up a pricing agreement to be reimbursed and complete the course of treatment that was agreed upon when the member was with their previous MCO
  • The Sept. 1, 2022, agreement change is only applicable to the geographic location of the member. Any UnitedHealthcare Community Plan of Pennsylvania network health care professional may continue to see UnitedHealthcare Community Plan members regardless of where the health care professional’s office/facility is located.
    • Health care professionals do not need to be located within the Southeast zone of Pennsylvania (Bucks, Chester, Delaware, Montgomery and Philadelphia counties) to serve UnitedHealthcare Community Plan members

Questions?

Call UnitedHealthcare Community Plan of Pennsylvania at 800-600-9007.

PCA-1-22-02985-C&S-News
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