bmco monthly physical health managed care program...
TRANSCRIPT
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: November 23, 2016
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 October 2016 ENROLLMENT BY PLAN AND BY COUNTY
SOUTHEAST
County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL
09 Bucks 5,072 7,267 11,062 38,219 61,620
15 Chester 12,098 7,098 2,396 21,763 43,355
23 Delaware 8,777 11,461 8,202 67,148 95,588
46 Montgomery 9,106 11,546 11,811 52,228 84,691
51 Philadelphia 53,899 37,104 210,076 236,584 537,663
TOTAL 88,952 74,476 243,547 415,942 822,917
PERCENTAGE 11% 9% 30% 51%
SOUTHWEST
County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL
02 Allegheny 59,882 19,398 97,425 6,836 183,541
03 Armstrong 1,163 483 10,198 423 12,267
04 Beaver 11,989 2,155 12,584 1,208 27,936
05 Bedford 773 1,132 5,848 741 8,494
07 Blair 6,959 3,822 12,460 2,143 25,384
10 Butler 5,722 970 13,414 917 21,023
11 Cambria 3,788 5,247 14,484 2,738 26,257
26 Fayette 4,325 9,535 18,978 781 33,619
30 Greene 848 3,536 3,064 381 7,829
32 Indiana 2,655 1,801 8,638 583 13,677
37 Lawrence 7,474 1,404 7,877 702 17,457
56 Somerset 1,965 2,860 6,111 1,050 11,986
63 Washington 5,869 4,938 17,916 1,278 30,001
65 Westmoreland 11,954 7,671 30,351 1,997 51,973
TOTAL 125,366 64,952 259,348 21,778 471,444
PERCENTAGE 26% 14% 55% 5%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
5
Mandatory October 2016 ENROLLMENT BY PLAN AND BY COUNTY
cont. LEHIGH/CAPITAL
County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL
01 Adams 4,234 4,567 1,117 1,245 1,422 12,585
06 Berks 15,443 8,532 6,049 6,390 39,176 75,590
21 Cumberland 12,104 3,415 3,754 1,289 4,748 25,310
22 Dauphin 28,473 9,819 6,933 4,051 5,476 54,752
28 Franklin 804 709 7,834 496 12,578 22,421
29 Fulton 161 338 724 605 668 2,496
31 Huntingdon 531 648 963 3,576 1,616 7,334
36 Lancaster 23,779 10,144 3,602 8,502 28,567 74,594
38 Lebanon 14,072 1,702 1,643 1,839 3,004 22,260
39 Lehigh 21,482 4,316 4,210 4,334 33,271 67,613
48 Northampton 13,320 2,380 3,245 2,223 22,412 43,580
50 Perry 3,654 566 588 220 876 5,904
67 York 22,171 21,117 6,584 6,378 13,472 69,722
TOTAL 160,228 68,253 47,246 41,148 167,286 484,161
PERCENTAGE 33% 14% 10% 8% 35%
NORTHWEST
County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL
12 Cameron 811 31 117 48 1,007
16 Clarion 3,969 875 620 663 6,127
17 Clearfield 10,651 1,479 1,973 1,671 15,774
20 Crawford 11,691 961 1,147 1,242 15,041
24 Elk 3,522 464 271 254 4,511
25 Erie 30,825 15,081 6,015 9,531 61,452
27 Forest 532 106 88 54 780
33 Jefferson 6,561 1,015 377 469 8,422
42 McKean 6,014 354 1,260 728 8,356
43 Mercer 13,472 3,850 2,177 2,236 21,735
53 Potter 1,896 50 1,327 85 3,358
61 Venango 6,917 932 1,106 1,130 10,085
62 Warren 4,495 717 793 498 6,503
TOTAL 101,356 25,915 17,271 18,609 163,151
PERCENTAGE 62% 16% 11% 11%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
6
Mandatory October 2016 ENROLLMENT BY PLAN AND BY COUNTY
cont.
NORTHEAST
County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL
08 Bradford 2,845 4,484 3,595 10,924
13 Carbon 6,420 2,674 1,179 10,273
14 Centre 2,538 6,278 2,487 11,303
18 Clinton 1,084 5,032 799 6,915
19 Columbia 1,444 6,971 1,161 9,576
34 Juniata 739 1,680 652 3,071
35 Lackawanna 6,876 28,914 5,216 41,006
40 Luzerne 15,852 40,733 10,638 67,223
41 Lycoming 4,998 14,766 1,454 21,218
44 Mifflin 2,018 4,652 1,604 8,274
45 Monroe 13,416 12,488 4,412 30,316
47 Montour 357 1,555 299 2,211
49 Northumberland 3,144 10,042 3,455 16,641
52 Pike 2,824 5,081 1,109 9,014
54 Schuylkill 8,139 14,724 3,261 26,124
55 Snyder 1,129 2,982 923 5,034
57 Sullivan 145 504 132 781
58 Susquehanna 1,116 4,387 923 6,426
59 Tioga 5,949 960 626 7,535
60 Union 969 2,692 778 4,439
64 Wayne 1,519 5,525 1,082 8,126
66 Wyoming 747 3,312 649 4,708
TOTAL 84,268 180,436 46,434 311,138
PERCENTAGE 27% 59% 15%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
7
Mandatory October 2016 MARKET SHARE BY PLAN – STATEWIDE
Total Enrollment = 2,252,811
AmeriHealth NE 84,268
4% Aetna
208,543 9%
AmeriHealth 184,557
8%
Gateway 311,509
14%
Health Partners 243,547
11%
Keystone 415,942
18%
United 222,157
10%
UPMC 401,852
18%
Geisinger 180,436
8%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16 8
9
Mandatory October 2016MARKET SHARE BY ZONE AND BY PLAN
Southeast
Aetna74,476
9%
Health Partners243,547
30%
Keystone415,942
50%
United88,952
11%
Lehigh/Capital
Aetna47,246
10%
Ameri-Health
167,28635%Gateway
160,22833%
United68,253
14%
UPMC41,148
8%
Southwest Aetna21,778
5%
Gateway125,366
26%
United64,952
14%
UPMC259,348
55%
Northwest
Aetna18,609
11%
Ameri-Health17,271
11%
Gateway25,915
16%
UPMC101,356
62%
Northeast
Aetna46,434
15%
Ameri-Health NE
84,26827%
Geisinger180,436
58%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
Mandatory October 2016 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 588 2,385 4,418 2,116 34,749 44,256
43 Aetna 712 1,215 5,134 2,511 23,280 32,852
45 Health Partners 1,274 416 4,563 3,557 104,473 114,283
47 Keystone 3,955 3,977 32,612 12,080 147,358 199,982
Southeast MCOs 6,529 7,993 46,727 20,264 309,860 391,373
American Indian or
Alaskan Native
42 United 13 28 19 15 62 137
43 Aetna 17 35 11 51 70 184
45 Health Partners 37 16 7 45 238 343
47 Keystone 96 71 106 161 305 739
Southeast MCOs 163 150 143 272 675 1,403
Asian
42 United 221 271 643 538 3,949 5,622
43 Aetna 286 157 555 790 1,530 3,318
45 Health Partners 530 59 357 654 7,371 8,971
47 Keystone 1,302 576 3,868 3,446 17,406 26,598
Southeast MCOs 2,339 1,063 5,423 5,428 30,256 44,509
White
42 United 3,470 6,716 2,830 4,670 7,347 25,033
43 Aetna 5,371 4,534 4,733 6,398 7,064 28,100
45 Health Partners 7,420 1,531 2,341 5,580 33,326 50,198
47 Keystone 27,948 13,345 25,073 27,800 39,577 133,743
Southeast MCOs 44,209 26,126 34,977 44,448 87,314 237,074
Other or system
default
42 United 512 2,049 559 1,258 6,417 10,795
43 Aetna 526 796 637 1,116 4,043 7,118
45 Health Partners 1,316 221 654 1,434 60,908 64,533
47 Keystone 3,676 2,976 4,137 6,757 27,429 44,975
Southeast MCOs 6,030 6,042 5,987 10,565 98,797 127,421
Native Hawaiian or
Other Pacific Islander
42 United 2 13 2 8 49 74
43 Aetna 5 6 13 12 36 72
45 Health Partners 14 0 4 5 131 154
47 Keystone 35 15 37 41 126 254
Southeast MCOs 56 34 56 66 342 554
Unknown
42 United 266 636 306 501 1,326 3,035
43 Aetna 350 355 378 668 1,081 2,832
45 Health Partners 471 153 276 536 3,629 5,065
47 Keystone 1,207 803 1,315 1,943 4,383 9,651
Southeast MCOs 2,294 1,947 2,275 3,648 10,419 20,583
MCO TOTAL
42 United 61,081 43,160 95,079 84,640 533,243 817,203
43 Aetna 7,267 7,098 11,461 11,546 37,104 74,476
45 Health Partners 11,062 2,396 8,202 11,811 210,076 243,547
47 Keystone 38,219 21,763 67,148 52,228 236,584 415,942
TOTAL 61,620 43,355 95,588 84,691 537,663 822,917
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
10
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Southwest 02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 07 Blair 10 Butler 11 Cambria 26 Fayette
Black or African
American
31 Gateway 28,636 37 2,816 18 446 218 448 406
32 United 8,060 10 420 11 253 14 832 841
34 UPMC 32,525 135 2,040 63 501 330 1,217 1,448
59 Aetna 2,440 7 239 16 128 22 677 86
Southwest MCOs 71,661 189 5,515 108 1,328 584 3,174 2,781
American Indian or
Alaskan Native
31 Gateway 113 2 11 0 5 3 7 11
32 United 40 2 0 1 11 0 2 10
34 UPMC 281 18 25 14 18 27 16 27
59 Aetna 17 0 4 1 8 0 2 3
Southwest MCOs 451 22 40 16 42 30 27 51
Asian
31 Gateway 763 1 29 1 28 27 8 20
32 United 397 2 19 2 21 18 13 12
34 UPMC 4,623 31 98 27 54 146 49 41
59 Aetna 198 0 10 3 11 11 10 3
Southwest MCOs 5,981 34 156 33 114 202 80 76
White
31 Gateway 27,634 1,112 8,861 739 6,388 5,343 3,231 3,812
32 United 9,711 461 1,638 1,104 3,471 892 4,264 8,523
34 UPMC 53,484 9,907 10,022 5,640 11,673 12,496 12,910 17,106
59 Aetna 3,608 410 917 707 1,966 838 1,987 669
Southwest MCOs 94,437 11,890 21,438 8,190 23,498 19,569 22,392 30,110
Other or system
default
31 Gateway 1,712 8 211 11 57 86 68 43
32 United 665 1 55 9 38 24 99 92
34 UPMC 3,767 47 246 81 108 202 177 145
59 Aetna 258 0 24 10 9 17 41 8
Southwest MCOs 6,402 56 536 111 212 329 385 288
Native Hawaiian or
Other Pacific Islander
31 Gateway 16 0 5 0 3 3 0 1
32 United 17 0 1 0 1 0 0 0
34 UPMC 57 1 2 5 4 2 2 17
59 Aetna 2 0 0 0 0 0 1 0
Southwest MCOs 92 1 8 5 8 5 3 18
Unknown
31 Gateway 1,008 3 56 4 32 42 26 32
32 United 508 7 22 5 27 22 37 57
34 UPMC 2,688 59 151 18 102 211 113 194
59 Aetna 313 6 14 4 21 29 20 12
Southwest MCOs 4,517 75 243 31 182 304 196 295
MCO TOTAL
31 Gateway 59,882 1,163 9,173 773 6,959 5,722 3,788 4,325
32 United 19,398 483 2,155 1,132 3,822 970 5,247 9,535
34 UPMC 97,425 10,198 12,584 5,848 12,460 13,414 14,484 18,978
59 Aetna 6,836 423 1,208 741 2,143 917 2,738 781
TOTAL 183,541 12,267 27,936 8,494 25,384 21,023 26,257 33,619
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
11
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Southwest cont.
30 Greene 32 Indiana 37 Lawrence 56 Somerset 63 Washington 65 Westmoreland Southwest
Black or African
American
31 Gateway 19 87 998 17 695 1,542 36,383
32 United 41 70 198 17 562 749 12,078
34 UPMC 40 246 804 39 1,523 2,069 42,980
59 Aetna 7 39 112 17 141 154 4,085
Southwest MCOs 107 442 2,112 90 2,921 4,514 95,526
American Indian or
Alaskan Native
31 Gateway 0 2 6 2 6 21 189
32 United 4 11 1 7 10 10 109
34 UPMC 7 5 13 17 35 44 547
59 Aetna 1 1 1 2 6 4 50
Southwest MCOs 12 19 21 28 57 79 895
Asian
31 Gateway 2 24 16 7 17 36 979
32 United 3 5 3 6 13 30 544
34 UPMC 10 56 40 9 105 210 5,499
59 Aetna 4 4 2 2 9 17 284
Southwest MCOs 19 89 61 24 144 293 7,306
White
31 Gateway 817 2,485 6,363 1,905 4,991 10,037 83,718
32 United 3,471 1,665 1,178 2,799 4,192 6,635 50,004
34 UPMC 2,966 8,146 6,883 5,942 15,607 27,073 199,855
59 Aetna 360 510 567 1,006 1,060 1,741 16,346
Southwest MCOs 7,614 12,806 14,991 11,652 25,850 45,486 349,923
Other or system
default
31 Gateway 8 32 45 23 75 183 2,562
32 United 9 26 17 17 82 133 1,267
34 UPMC 25 88 64 44 262 413 5,669
59 Aetna 3 17 8 13 20 34 462
Southwest MCOs 45 163 134 97 439 763 9,960
Native Hawaiian or
Other Pacific Islander
31 Gateway 0 0 1 1 0 2 32
32 United 1 2 1 0 4 2 29
34 UPMC 2 2 1 0 5 10 110
59 Aetna 0 0 0 0 0 1 4
Southwest MCOs 3 4 3 1 9 15 175
Unknown
31 Gateway 2 25 45 10 85 133 1,503
32 United 7 22 6 14 75 112 921
34 UPMC 14 95 72 60 379 532 4,688
59 Aetna 6 12 12 10 42 46 547
Southwest MCOs 29 154 135 94 581 823 7,659
MCO TOTAL
31 Gateway 848 2,655 7,474 1,965 5,869 11,954 125,366
32 United 3,536 1,801 1,404 2,860 4,938 7,671 64,952
34 UPMC 3,064 8,638 7,877 6,111 17,916 30,351 259,348
59 Aetna 381 583 702 1,050 1,278 1,997 21,778
TOTAL 7,829 13,677 17,457 11,986 30,001 51,973 471,444
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
12
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Lehigh/Capital 01 Adams 06 Berks 21 Cumberland 22 Dauphin 28 Franklin 29 Fulton 31 Huntingdon
Black or African
American
51 Gateway 159 1,440 1,431 11,203 68 2 28
52 United 229 765 426 3,748 53 6 19
53 Aetna 57 690 396 2,252 657 13 56
54 UPMC 45 531 105 1,248 43 10 126
57 AmeriHealth 70 3,434 435 1,682 1,062 14 50
Lehigh/Capital MCOs 560 6,860 2,793 20,133 1,883 45 279
American Indian or
Alaskan Native
51 Gateway 13 20 35 76 4 0 0
52 United 8 18 10 25 2 0 0
53 Aetna 3 5 9 31 19 2 0
54 UPMC 4 17 1 6 4 2 0
57 AmeriHealth 3 45 10 24 41 3 1
Lehigh/Capital MCOs 31 105 65 162 70 7 1
Asian
51 Gateway 33 167 330 1,484 2 0 1
52 United 27 131 128 442 2 0 1
53 Aetna 7 105 108 247 43 1 3
54 UPMC 10 86 34 192 0 0 14
57 AmeriHealth 9 279 100 187 106 0 1
Lehigh/Capital MCOs 86 768 700 2,552 153 1 20
White
51 Gateway 3,710 7,256 8,645 8,998 619 154 488
52 United 3,610 4,833 2,248 3,550 599 326 614
53 Aetna 938 3,668 2,800 3,226 6,255 695 891
54 UPMC 1,051 3,675 960 1,920 409 592 3,379
57 AmeriHealth 1,222 13,369 3,584 2,294 9,348 635 1,538
Lehigh/Capital MCOs 10,531 32,801 18,237 19,988 17,230 2,402 6,910
Other or system
default
51 Gateway 212 6,223 1,251 5,822 63 1 13
52 United 575 2,516 438 1,626 29 5 10
53 Aetna 80 1,387 262 851 579 11 8
54 UPMC 76 1,840 125 498 21 0 43
57 AmeriHealth 72 21,189 419 981 1,418 12 15
Lehigh/Capital MCOs 1,015 33,155 2,495 9,778 2,110 29 89
Native Hawaiian or
Other Pacific
Islander
51 Gateway 1 2 10 23 0 0 0
52 United 3 10 3 7 0 0 0
53 Aetna 1 4 2 7 7 0 0
54 UPMC 2 4 1 2 0 1 2
57 AmeriHealth 0 22 7 5 13 1 1
Lehigh/Capital MCOs 7 42 23 44 20 2 3
Unknown
51 Gateway 106 335 402 867 48 4 1
52 United 115 259 162 421 24 1 4
53 Aetna 31 190 177 319 274 2 5
54 UPMC 57 237 63 185 19 0 12
57 AmeriHealth 46 838 193 303 590 3 10
Lehigh/Capital MCOs 355 1,859 997 2,095 955 10 32
MCO TOTAL
51 Gateway 4,234 15,443 12,104 28,473 804 161 531
52 United 4,567 8,532 3,415 9,819 709 338 648
53 Aetna 1,117 6,049 3,754 6,933 7,834 724 963
54 UPMC 1,245 6,390 1,289 4,051 496 605 3,576
57 AmeriHealth 1,422 39,176 4,748 5,476 12,578 668 1,616
TOTAL 12,585 75,590 25,310 54,752 22,421 2,496 7,334
13
Racial/Ethnic
information is self-
reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Lehigh/Capital cont. 36 Lancaster 38 Lebanon 39 Lehigh 48 Northampton 50 Perry 67 York Lehigh/Capital
Black or African
American
51 Gateway 2,003 596 2,954 1,835 44 2,437 24,200
52 United 1,201 93 615 284 12 3,848 11,299
53 Aetna 423 82 713 435 22 1,047 6,843
54 UPMC 763 109 597 261 9 943 4,790
57 AmeriHealth 3,216 165 3,702 2,380 10 2,193 18,413
Lehigh/Capital MCOs 7,606 1,045 8,581 5,195 97 10,468 65,545
American Indian or
Alaskan Native
51 Gateway 35 11 32 36 2 76 340
52 United 28 0 8 3 0 45 147
53 Aetna 23 1 4 9 1 17 124
54 UPMC 29 4 8 5 0 26 106
57 AmeriHealth 51 5 49 46 0 51 329
Lehigh/Capital MCOs 166 21 101 99 3 215 1,046
Asian
51 Gateway 991 106 287 192 7 217 3,817
52 United 292 27 88 53 4 224 1,419
53 Aetna 106 16 114 85 5 97 937
54 UPMC 288 15 120 63 0 68 890
57 AmeriHealth 702 52 570 433 0 159 2,598
Lehigh/Capital MCOs 2,379 216 1,179 826 16 765 9,661
White
51 Gateway 15,158 9,611 15,203 7,802 3,498 16,227 97,369
52 United 5,779 1,202 3,048 1,644 524 12,027 40,004
53 Aetna 2,244 1,199 2,835 2,236 537 4,371 31,895
54 UPMC 5,460 1,294 3,022 1,483 198 4,236 27,679
57 AmeriHealth 14,697 1,692 24,567 14,329 838 8,219 96,332
Lehigh/Capital MCOs 43,338 14,998 48,675 27,494 5,595 45,080 293,279
Other or system
default
51 Gateway 4,735 3,423 2,667 3,167 74 2,741 30,392
52 United 2,424 324 402 303 18 4,467 13,137
53 Aetna 608 296 399 334 13 789 5,617
54 UPMC 1,448 352 431 292 9 849 5,984
57 AmeriHealth 8,729 970 3,794 4,696 19 2,475 44,789
Lehigh/Capital MCOs 17,944 5,365 7,693 8,792 133 11,321 99,919
Native Hawaiian or
Other Pacific
Islander
51 Gateway 2 9 7 11 0 12 77
52 United 9 1 11 3 1 19 67
53 Aetna 6 1 11 7 0 4 50
54 UPMC 5 0 10 5 0 2 34
57 AmeriHealth 22 4 24 17 0 13 129
Lehigh/Capital MCOs 44 15 63 43 1 50 357
Unknown
51 Gateway 855 316 332 277 29 461 4,033
52 United 411 55 144 90 7 487 2,180
53 Aetna 192 48 134 139 10 259 1,780
54 UPMC 509 65 146 114 4 254 1,665
57 AmeriHealth 1,150 116 565 511 9 362 4,696
Lehigh/Capital MCOs 3,117 600 1,321 1,131 59 1,823 14,354
MCO TOTAL
51 Gateway 23,779 14,072 21,482 13,320 3,654 22,171 160,228
52 United 10,144 1,702 4,316 2,380 566 21,117 68,253
53 Aetna 3,602 1,643 4,210 3,245 588 6,584 47,246
54 UPMC 8,502 1,839 4,334 2,223 220 6,378 41,148
57 AmeriHealth 28,567 3,004 33,271 22,412 876 13,472 167,286
TOTAL 74,594 22,260 67,613 43,580 5,904 69,722 484,161
Racial/Ethnic information is
self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
14
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Northwest 12 Cameron 16 Clarion 17 Clearfield 20 Crawford 24 Elk 25 Erie 27 Forest
Black or African
American
35 UPMC 21 100 110 398 33 4,698 3
36 Gateway 1 25 24 40 6 3,814 1
37 AmeriHealth 3 16 32 37 3 1,343 0
56 Aetna 1 24 21 51 2 2,263 0
New West MCOs 26 165 187 526 44 12,118 4
American Indian or
Alaskan Native
35 UPMC 1 8 5 20 10 87 2
36 Gateway 0 0 0 2 0 34 4
37 AmeriHealth 0 2 2 1 3 11 0
56 Aetna 1 1 0 0 0 33 0
New West MCOs 2 11 7 23 13 165 6
Asian
35 UPMC 2 16 48 34 4 1,478 0
36 Gateway 0 4 2 0 2 250 0
37 AmeriHealth 0 8 9 1 0 178 0
56 Aetna 0 4 7 0 1 113 0
New West MCOs 2 32 66 35 7 2,019 0
White
35 UPMC 780 3,781 10,394 11,070 3,442 22,708 522
36 Gateway 30 834 1,438 905 455 9,935 100
37 AmeriHealth 113 582 1,913 1,092 260 4,156 87
56 Aetna 46 626 1,618 1,183 251 6,521 53
New West MCOs 969 5,823 15,363 14,250 4,408 43,320 762
Other or system
default
35 UPMC 5 25 44 82 16 1,529 3
36 Gateway 0 6 9 4 0 930 1
37 AmeriHealth 1 5 9 5 5 267 1
56 Aetna 0 4 10 4 0 516 1
New West MCOs 6 40 72 95 21 3,242 6
Native Hawaiian or
Other Pacific Islander
35 UPMC 0 1 1 6 1 12 0
36 Gateway 0 0 0 0 0 7 0
37 AmeriHealth 0 0 0 0 0 1 0
56 Aetna 0 1 1 0 0 2 0
New West MCOs 0 2 2 6 1 22 0
Unknown
35 UPMC 2 38 49 81 16 313 2
36 Gateway 0 6 6 10 1 111 0
37 AmeriHealth 0 7 8 11 0 59 0
56 Aetna 0 3 14 4 0 83 0
New West MCOs 2 54 77 106 17 566 2
MCO TOTAL
35 UPMC 811 3,969 10,651 11,691 3,522 30,825 532
36 Gateway 31 875 1,479 961 464 15,081 106
37 AmeriHealth 117 620 1,973 1,147 271 6,015 88
56 Aetna 48 663 1,671 1,242 254 9,531 54
TOTAL 1,007 6,127 15,774 15,041 4,511 61,452 780Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
15
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Northwest cont.
33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren New West
Black or African
American
35 UPMC 60 63 1,722 10 164 35 7,417
36 Gateway 9 6 718 1 30 10 4,685
37 AmeriHealth 11 7 441 14 30 7 1,944
56 Aetna 6 4 454 0 40 6 2,872
New West MCOs 86 80 3,335 25 264 58 16,918
American Indian or
Alaskan Native
35 UPMC 11 13 8 4 10 13 192
36 Gateway 1 2 3 0 5 1 52
37 AmeriHealth 1 5 6 2 3 1 37
56 Aetna 1 1 1 0 2 2 42
New West MCOs 14 21 18 6 20 17 323
Asian
35 UPMC 17 21 80 3 21 16 1,740
36 Gateway 5 0 18 0 5 0 286
37 AmeriHealth 2 9 19 0 3 2 231
56 Aetna 0 0 15 0 2 2 144
New West MCOs 24 30 132 3 31 20 2,401
White
35 UPMC 6,418 5,863 11,343 1,852 6,631 4,395 89,199
36 Gateway 995 341 3,036 48 876 699 19,692
37 AmeriHealth 358 1,228 1,657 1,295 1,054 774 14,569
56 Aetna 456 719 1,716 83 1,071 481 14,824
New West MCOs 8,227 8,151 17,752 3,278 9,632 6,349 138,284
Other or system
default
35 UPMC 35 33 161 12 47 22 2,014
36 Gateway 5 4 43 0 8 2 1,012
37 AmeriHealth 3 5 30 9 11 5 356
56 Aetna 4 2 20 0 11 4 576
New West MCOs 47 44 254 21 77 33 3,958
Native Hawaiian or
Other Pacific Islander
35 UPMC 1 3 5 0 2 1 33
36 Gateway 0 0 1 0 0 0 8
37 AmeriHealth 0 3 1 1 1 1 8
56 Aetna 0 0 0 0 0 0 4
New West MCOs 1 6 7 1 3 2 53
Unknown
35 UPMC 19 18 153 15 42 13 761
36 Gateway 0 1 31 1 8 5 180
37 AmeriHealth 2 3 23 6 4 3 126
56 Aetna 2 2 30 2 4 3 147
New West MCOs 23 24 237 24 58 24 1,214
MCO TOTAL
35 UPMC 6,561 6,014 13,472 1,896 6,917 4,495 101,356
36 Gateway 1,015 354 3,850 50 932 717 25,915
37 AmeriHealth 377 1,260 2,177 1,327 1,106 793 17,271
56 Aetna 469 728 2,236 85 1,130 498 18,609
TOTAL 8,422 8,356 21,735 3,358 10,085 6,503 163,151
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
16
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Northeast
08 Bradford 13 Carbon 14 Centre 18 Clinton 19 Columbia 34 Juniata 35 Lackawanna 40 Luzerne
Black or African American
41 AmeriHealth NE 34 190 121 20 79 12 774 1,801
44 Geisinger 58 97 262 82 215 16 2,237 3,912
50 Aetna Better Health 48 46 141 27 64 14 631 1,323
New East MCOs 140 333 524 129 358 42 3,642 7,036
American Indian or Alaskan
Native
41 AmeriHealth NE 6 10 4 2 8 2 14 26
44 Geisinger 7 4 24 6 10 0 56 41
50 Aetna Better Health 4 3 15 2 3 2 8 7
New East MCOs 17 17 43 10 21 4 78 74
Asian
41 AmeriHealth NE 10 14 67 4 13 0 209 100
44 Geisinger 20 15 147 13 37 7 1,001 346
50 Aetna Better Health 17 3 98 0 13 2 213 90
New East MCOs 47 32 312 17 63 9 1,423 536
White
41 AmeriHealth NE 2,756 5,941 2,247 1,038 1,291 663 4,854 9,581
44 Geisinger 4,357 2,426 5,669 4,831 6,546 1,504 21,482 29,528
50 Aetna Better Health 3,484 1,048 2,125 747 1,024 595 3,645 6,670
New East MCOs 10,597 9,415 10,041 6,616 8,861 2,762 29,981 45,779
Other or system default
41 AmeriHealth NE 24 185 61 11 36 49 906 4,136
44 Geisinger 26 98 85 55 98 138 3,655 6,354
50 Aetna Better Health 27 57 52 13 39 29 598 2,375
New East MCOs 77 340 198 79 173 216 5,159 12,865
Native Hawaiian or Other
Pacific Islander
41 AmeriHealth NE 1 2 0 0 0 0 3 4
44 Geisinger 0 0 4 2 1 0 14 22
50 Aetna Better Health 1 2 3 0 1 1 3 8
New East MCOs 2 4 7 2 2 1 20 34
Unknown
41 AmeriHealth NE 14 78 38 9 17 13 116 204
44 Geisinger 16 34 87 43 64 15 469 530
50 Aetna Better Health 14 20 53 10 17 9 118 165
New East MCOs 44 132 178 62 98 37 703 899
MCO TOTAL
41 AmeriHealth NE 2,845 6,420 2,538 1,084 1,444 739 6,876 15,852
44 Geisinger 4,484 2,674 6,278 5,032 6,971 1,680 28,914 40,733
50 Aetna Better Health 3,595 1,179 2,487 799 1,161 652 5,216 10,638
TOTAL 10,924 10,273 11,303 6,915 9,576 3,071 41,006 67,223
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
17
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Northeast cont.
41 Lycoming 44 Mifflin 45 Monroe 47 Montour 49 Northumberland 52 Pike 54 Schuylkill 55 Snyder
Black or African
American
41 AmeriHealth NE 894 47 2,259 17 165 346 311 38 44 Geisinger 2,025 86 2,249 37 353 328 516 95 50 Aetna Better Health 196 35 1,044 5 174 107 126 22 New East MCOs 3,115 168 5,552 59 692 781 953 155
American Indian or
Alaskan Native
41 AmeriHealth NE 5 5 24 0 11 10 13 2 44 Geisinger 28 7 34 4 14 12 18 3 50 Aetna Better Health 1 0 13 1 5 4 9 2 New East MCOs 34 12 71 5 30 26 40 7
Asian
41 AmeriHealth NE 27 7 164 3 11 24 48 17 44 Geisinger 58 14 172 16 45 61 73 9 50 Aetna Better Health 12 14 60 5 17 4 13 4 New East MCOs 97 35 396 24 73 89 134 30
White
41 AmeriHealth NE 3,957 1,928 8,330 330 2,734 2,086 7,298 1,031 44 Geisinger 12,405 4,453 7,594 1,442 9,140 4,309 13,434 2,765 50 Aetna Better Health 1,206 1,516 2,334 279 3,109 845 2,955 865 New East MCOs 17,568 7,897 18,258 2,051 14,983 7,240 23,687 4,661
Other or system default
41 AmeriHealth NE 66 27 2,217 5 182 280 400 31 44 Geisinger 153 78 2,064 37 359 279 546 73 50 Aetna Better Health 18 34 795 6 115 114 134 15 New East MCOs 237 139 5,076 48 656 673 1,080 119
Native Hawaiian or
Other Pacific Islander
41 AmeriHealth NE 7 1 30 0 0 1 3 0 44 Geisinger 7 2 11 4 7 8 8 3 50 Aetna Better Health 2 2 9 0 2 2 0 0 New East MCOs 16 5 50 4 9 11 11 3
Unknown
41 AmeriHealth NE 42 3 392 2 41 77 66 10 44 Geisinger 90 12 364 15 124 84 129 34 50 Aetna Better Health 19 3 157 3 33 33 24 15 New East MCOs 151 18 913 20 198 194 219 59
MCO TOTAL
41 AmeriHealth NE 4,998 2,018 13,416 357 3,144 2,824 8,139 1,129
44 Geisinger 14,766 4,652 12,488 1,555 10,042 5,081 14,724 2,982
50 Aetna Better Health 1,454 1,604 4,412 299 3,455 1,109 3,261 923
TOTAL 21,218 8,274 30,316 2,211 16,641 9,014 26,124 5,034
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
18
Mandatory October 2016 ENROLLMENT BY PLAN, BY RACE AND BY COUNTY
Northeast cont.
57 Sullivan 58 Susquehanna 59 Tioga 60 Union 64 Wayne 66 Wyoming New East
Black or African American
41 AmeriHealth NE 1 4 96 42 39 9 7,299
44 Geisinger 5 29 17 181 103 24 12,927
50 Aetna Better Health 7 11 16 44 31 8 4,120
New East MCOs 13 44 129 267 173 41 24,346
American Indian or Alaskan
Native
41 AmeriHealth NE 1 0 12 0 4 0 159
44 Geisinger 1 2 2 4 20 3 300
50 Aetna Better Health 0 0 1 1 2 1 84
New East MCOs 2 2 15 5 26 4 543
Asian
41 AmeriHealth NE 1 2 17 5 10 0 753
44 Geisinger 1 14 5 19 31 10 2,114
50 Aetna Better Health 0 2 0 0 5 2 574
New East MCOs 2 18 22 24 46 12 3,441
White
41 AmeriHealth NE 138 1,096 5,760 886 1,425 723 66,093
44 Geisinger 493 4,278 915 2,390 5,206 3,221 148,388
50 Aetna Better Health 124 896 592 715 999 627 36,400
New East MCOs 755 6,270 7,267 3,991 7,630 4,571 250,881
Other or system default
41 AmeriHealth NE 4 11 42 29 31 9 8,742
44 Geisinger 4 29 8 81 100 28 14,348
50 Aetna Better Health 1 11 9 10 24 8 4,484
New East MCOs 9 51 59 120 155 45 27,574
Native Hawaiian or Other
Pacific Islander
41 AmeriHealth NE 0 0 1 0 0 1 54
44 Geisinger 0 1 1 1 2 1 99
50 Aetna Better Health 0 0 1 0 0 0 37
New East MCOs 0 1 3 1 2 2 190
Unknown
41 AmeriHealth NE 0 3 21 7 10 5 1,168
44 Geisinger 0 34 12 16 63 25 2,260
50 Aetna Better Health 0 3 7 8 21 3 735
New East MCOs 0 40 40 31 94 33 4,163
MCO TOTAL
41 AmeriHealth NE 145 1,116 5,949 969 1,519 747 84,268
44 Geisinger 504 4,387 960 2,692 5,525 3,312 180,436
50 Aetna Better Health 132 923 626 778 1,082 649 46,434
TOTAL 781 6,426 7,535 4,439 8,126 4,708 311,138
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
19
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Southeast
09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast
Other/Unknown
42 United 42 63 36 60 161 362
43 Aetna 45 34 37 59 172 347
45 Health Partners 44 38 39 68 238 427
47 Keystone 115 42 80 158 273 668
Southeast MCOs 246 177 192 345 844 1,804
Non-Hispanic
42 United 4,479 8,991 8,278 7,841 47,648 77,237
43 Aetna 6,651 5,915 10,870 10,629 33,041 67,106
45 Health Partners 9,576 2,076 7,563 10,492 144,991 174,698
47 Keystone 34,178 17,673 63,687 46,384 210,804 372,726
Southeast MCOs 54,884 34,655 90,398 75,346 436,484 691,767
Hispanic
42 United 551 3,044 463 1,205 6,090 11,353
43 Aetna 571 1,149 554 858 3,891 7,023
45 Health Partners 1,442 282 600 1,251 64,847 68,422
47 Keystone 3,926 4,048 3,381 5,686 25,507 42,548
Southeast MCOs 6,490 8,523 4,998 9,000 100,335 129,346
TOTAL 61,620 43,355 95,588 84,691 537,663 822,917
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
20
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Southwest
02 Allegheny 03 Armstrong 04 Beaver 05 Bedford 07 Blair 10 Butler 11 Cambria 26 Fayette
Other/Unknown
31 Gateway 82 1 5 1 3 9 4 7
32 United 95 2 8 2 3 4 6 8
34 UPMC 294 7 12 8 26 36 16 28
59 Aetna 62 1 2 3 2 10 3 3
Southwest MCOs 533 11 27 14 34 59 29 46
Non-Hispanic
31 Gateway 58,993 1,150 11,851 764 6,880 5,594 3,726 4,284
32 United 18,990 480 2,114 1,124 3,767 938 5,147 9,464
34 UPMC 95,078 10,125 12,413 5,773 12,284 13,150 14,314 18,783
59 Aetna 6,636 421 1,185 727 2,115 889 2,694 767
Southwest MCOs 179,697 12,176 27,563 8,388 25,046 20,571 25,881 33,298
Hispanic
31 Gateway 807 12 133 8 76 119 58 34
32 United 313 1 33 6 52 28 94 63
34 UPMC 2,053 66 159 67 150 228 154 167
59 Aetna 138 1 21 11 26 18 41 11
Southwest MCOs 3,311 80 346 92 304 393 347 275
TOTAL 183,541 12,267 27,936 8,494 25,384 21,023 26,257 33,619
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
21
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Southwest cont.
30 Greene 32 Indiana 37 Lawrence 56 Somerset 63 Washington 65 Westmoreland Southwest
Other/Unknown
31 Gateway 1 3 1 0 7 17 141
32 United 5 14 1 1 6 22 177
34 UPMC 5 18 5 3 25 51 534
59 Aetna 0 5 2 0 4 9 106
Southwest MCOs 11 40 9 4 42 99 958
Non-Hispanic
31 Gateway 844 2,628 7,425 1,944 5,788 11,822 123,693
32 United 3,520 1,763 1,386 2,834 4,867 7,555 63,949
34 UPMC 3,038 8,536 7,771 6,051 17,645 29,971 254,932
59 Aetna 379 562 694 1,036 1,256 1,945 21,306
Southwest MCOs 7,781 13,489 17,276 11,865 29,556 51,293 463,880
Hispanic
31 Gateway 3 24 48 21 74 115 1,532
32 United 11 24 17 25 65 94 826
34 UPMC 21 84 101 57 246 329 3,882
59 Aetna 2 16 6 14 18 43 366
Southwest MCOs 37 148 172 117 403 581 6,606
TOTAL 7,829 13,677 17,457 11,986 30,001 51,973 471,444
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
22
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Lehigh/Capital
01 Adams 06 Berks 21 Cumberland 22 Dauphin 28 Franklin 29 Fulton 31 Huntingdon
Other/Unknown
51 Gateway 6 16 25 52 7 4 4
52 United 9 18 18 62 2 0 0
53 Aetna 5 34 26 34 19 0 0
54 UPMC 4 25 5 23 12 0 4
57 AmeriHealth 4 43 24 25 41 1 0
Lehigh/Capital MCOs 28 136 98 196 81 5 8
Non-Hispanic
51 Gateway 3,898 8,490 11,272 22,543 733 155 511
52 United 3,667 5,759 3,058 8,206 671 335 638
53 Aetna 979 4,457 3,519 6,140 7,242 709 954
54 UPMC 1,090 4,274 1,198 3,592 458 601 3,534
57 AmeriHealth 1,288 15,826 4,386 4,429 10,762 656 1,605
Lehigh/Capital MCOs 10,922 38,806 23,433 44,910 19,866 2,456 7,242
Hispanic
51 Gateway 330 6,937 807 5,878 64 2 16
52 United 891 2,755 339 1,551 36 3 10
53 Aetna 133 1,558 209 759 573 15 9
54 UPMC 151 2,091 86 436 26 4 38
57 AmeriHealth 130 23,307 338 1,022 1,775 11 11
Lehigh/Capital MCOs 1,635 36,648 1,779 9,646 2,474 35 84
TOTAL 12,585 75,590 25,310 54,752 22,421 2,496 7,334
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
23
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Lehigh/Capital cont.
36 Lancaster 38 Lebanon 39 Lehigh 48 Northampton 50 Perry 67 York Lehigh/Capital
Other/Unknown
51 Gateway 33 5 22 26 7 34 241
52 United 28 3 21 20 1 61 243
53 Aetna 18 4 21 22 1 43 227
54 UPMC 39 8 21 23 1 36 201
57 AmeriHealth 57 6 68 56 2 36 363
Lehigh/Capital MCOs 175 26 153 147 12 210 1,275
Non-Hispanic
51 Gateway 18,578 9,269 10,097 8,831 3,547 19,338 117,262
52 United 7,365 1,237 2,475 1,956 549 16,131 52,047
53 Aetna 2,902 1,242 2,649 2,729 569 5,695 39,786
54 UPMC 6,799 1,330 2,831 1,760 209 5,389 33,065
57 AmeriHealth 18,316 1,624 17,061 15,880 860 10,609 103,302
Lehigh/Capital MCOs 53,960 14,702 35,113 31,156 5,734 57,162 345,462
Hispanic
51 Gateway 5,168 4,798 11,363 4,463 100 2,799 42,725
52 United 2,751 462 1,820 404 16 4,925 15,963
53 Aetna 682 397 1,540 494 18 846 7,233
54 UPMC 1,664 501 1,482 440 10 953 7,882
57 AmeriHealth 10,194 1,374 16,142 6,476 14 2,827 63,621
Lehigh/Capital MCOs 20,459 7,532 32,347 12,277 158 12,350 137,424
TOTAL 74,594 22,260 67,613 43,580 5,904 69,722 484,161
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
24
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Northwest
12 Cameron 16 Clarion 17 Clearfield 20 Crawford 24 Elk 25 Erie 27 Forest
Other/Unknown
35 UPMC 0 7 6 14 1 44 2
36 Gateway 0 2 1 0 1 6 0
37 AmeriHealth 0 6 0 4 0 6 0
56 Aetna 0 1 3 3 0 6 0
New West MCOs 0 16 10 21 2 62 2
Non-Hispanic
35 UPMC 792 3,929 10,578 11,559 3,492 28,930 529
36 Gateway 30 871 1,471 954 461 13,770 102
37 AmeriHealth 116 611 1,951 1,136 266 5,659 88
56 Aetna 47 653 1,656 1,224 251 8,855 54
New West MCOs 985 6,064 15,656 14,873 4,470 57,214 773
Hispanic
35 UPMC 19 33 67 118 29 1,851 1
36 Gateway 1 2 7 7 2 1,305 4
37 AmeriHealth 1 3 22 7 5 350 0
56 Aetna 1 9 12 15 3 670 0
New West MCOs 22 47 108 147 39 4,176 5
TOTAL 1,007 6,127 15,774 15,041 4,511 61,452 780
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
25
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Northwest cont.
33 Jefferson 42 McKean 43 Mercer 53 Potter 61 Venango 62 Warren New West
Other/Unknown
35 UPMC 6 3 33 6 6 5 133
36 Gateway 0 0 7 0 1 0 18
37 AmeriHealth 0 0 12 1 1 0 30
56 Aetna 2 0 4 0 1 1 21
New West MCOs 8 3 56 7 9 6 202
Non-Hispanic
35 UPMC 6,496 5,934 13,294 1,874 6,831 4,469 98,707
36 Gateway 1,011 349 3,805 47 923 706 24,500
37 AmeriHealth 375 1,254 2,135 1,318 1,088 785 16,782
56 Aetna 466 726 2,200 85 1,113 497 17,827
New West MCOs 8,348 8,263 21,434 3,324 9,955 6,457 157,816
Hispanic
35 UPMC 59 77 145 16 80 21 2,516
36 Gateway 4 5 38 3 8 11 1,397
37 AmeriHealth 2 6 30 8 17 8 459
56 Aetna 1 2 32 0 16 0 761
New West MCOs 66 90 245 27 121 40 5,133
TOTAL 8,422 8,356 21,735 3,358 10,085 6,503 163,151
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
26
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Northeast
08 Bradford 13 Carbon 14 Centre 18 Clinton 19 Columbia 34 Juniata 35 Lackawanna 40 Luzerne
Other/Unknown
41 AmeriHealth NE 5 9 13 1 5 2 17 36
44 Geisinger 8 8 21 13 4 3 69 67
50 Aetna 2 4 19 1 1 1 34 30
New East MCOs 15 21 53 15 10 6 120 133
Non-Hispanic
41 AmeriHealth NE 2,801 5,969 2,463 1,066 1,366 683 5,729 11,006
44 Geisinger 4,417 2,503 6,122 4,944 6,765 1,525 24,433 32,989
50 Aetna 3,563 1,089 2,399 781 1,098 612 4,424 7,780
New East MCOs 10,781 9,561 10,984 6,791 9,229 2,820 34,586 51,775
Hispanic
41 AmeriHealth NE 39 442 62 17 73 54 1,130 4,810
44 Geisinger 59 163 135 75 202 152 4,412 7,677
50 Aetna 30 86 69 17 62 39 758 2,828
New East MCOs 128 691 266 109 337 245 6,300 15,315
TOTAL 10,924 10,273 11,303 6,915 9,576 3,071 41,006 67,223
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16 27
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Northeast cont.
41 Lycoming 44 Mifflin 45 Monroe 47 Montour 49 Northumberland 52 Pike 54 Schuylkill 55 Snyder
Other/Unknown
41 AmeriHealth
NE 17 1 23 0 12 13 8 4
44 Geisinger 31 2 36 2 16 18 6 5
50 Aetna 8 1 23 1 3 1 11 5
New East MCOs 56 4 82 3 31 32 25 14
Non-Hispanic
41 AmeriHealth
NE 4,876 1,954 10,997 346 2,864 2,386 7,406 1,084
44 Geisinger 14,537 4,517 10,203 1,499 9,413 4,613 13,742 2,883
50 Aetna 1,417 1,540 3,446 287 3,280 946 3,039 903
New East MCOs 20,830 8,011 24,646 2,132 15,557 7,945 24,187 4,870
Hispanic
41 AmeriHealth
NE 105 63 2,396 11 268 425 725 41
44 Geisinger 198 133 2,249 54 613 450 976 94
50 Aetna 29 63 943 11 172 162 211 15
New East MCOs 332 259 5,588 76 1,053 1,037 1,912 150
TOTAL 21,218 8,274 30,316 2,211 16,641 9,014 26,124 5,034
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
28
Mandatory October 2016 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Northeast cont.
57 Sullivan 58 Susquehanna 59 Tioga 60 Union 64 Wayne 66 Wyoming New East
Other/Unknown
41 AmeriHealth NE 0 0 2 2 4 1 175
44 Geisinger 1 8 0 7 14 13 352
50 Aetna 0 0 2 4 3 1 155
New East MCOs 1 8 4 13 21 15 682
Non-Hispanic
41 AmeriHealth NE 136 1,099 5,895 891 1,460 734 73,211
44 Geisinger 490 4,290 955 2,514 5,287 3,244 161,885
50 Aetna 129 906 614 734 1,033 641 40,661
New East MCOs 755 6,295 7,464 4,139 7,780 4,619 275,757
Hispanic
41 AmeriHealth NE 9 17 52 76 55 12 10,882
44 Geisinger 13 89 5 171 224 55 18,199
50 Aetna 3 17 10 40 46 7 5,618
New East MCOs 25 123 67 287 325 74 34,699
TOTAL 781 6,426 7,535 4,439 8,126 4,708 311,138
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
29
Mandatory October 2016 PLAN MAKE UP BY AGE GROUP AND GENDER
SOUTHEAST
42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL
< 21 Yrs
Female 22,614 18,401 59,648 112,635 213,298
Male 23,457 19,610 60,496 120,245 223,808
Total 46,071 38,011 120,144 232,880 437,106
22-45 Yrs
Female 16,259 13,857 51,200 77,308 158,624
Male 12,596 12,235 27,811 42,060 94,702
Total 28,855 26,092 79,011 119,368 253,326
46-64 Yrs
Female 6,627 4,523 23,885 33,766 68,801
Male 6,809 5,442 19,107 27,642 59,000
Total 13,436 9,965 42,992 61,408 127,801
Over 64
Yrs
Female 360 256 906 1,433 2,955
Male 230 152 494 853 1,729
Total 590 408 1,400 2,286 4,684
TOTAL 88,952 74,476 243,547 415,942 822,917
SOUTHWEST
31 Gateway 32 United 34 UPMC 59 Aetna TOTAL
< 21 Yrs Female 32,940 16,920 62,103 4,675 116,638
Male 35,096 18,038 65,304 4,709 123,147
Total 68,036 34,958 127,407 9,384 239,785
22-45 Yrs Female 24,689 12,078 53,134 4,513 94,414
Male 13,357 8,432 32,480 4,211 58,480
Total 38,046 20,510 85,614 8,724 152,894
46-64 Yrs Female 10,924 4,983 25,484 1,706 43,097
Male 8,087 4,356 20,133 1,911 34,487
Total 19,011 9,339 45,617 3,617 77,584
Over 64
Yrs
Female 157 86 433 30 706
Male 116 59 277 23 475
Total 273 145 710 53 1,181
TOTAL 125,366 64,952 259,348 21,778 471,444
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16 30
Mandatory October 2016 PLAN MAKE UP BY AGE GROUP AND GENDER
LEHIGH/CAPITAL
51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL
< 21 Yrs
Female 46,455 19,655 11,784 9,799 46,920 134,613
Male 48,797 20,560 12,398 10,440 49,102 141,297
Total 95,252 40,215 24,182 20,239 96,022 275,910
22-45 Yrs
Female 30,888 12,395 9,764 8,800 32,825 94,672
Male 14,517 7,358 6,653 5,898 15,867 50,293
Total 45,405 19,753 16,417 14,698 48,692 144,965
46-64 Yrs
Female 11,052 4,405 3,347 3,238 13,024 35,066
Male 7,898 3,616 3,113 2,814 8,788 26,229
Total 18,950 8,021 6,460 6,052 21,812 61,295
Over 64
Yrs
Female 401 158 115 100 515 1,289
Male 220 106 72 59 245 702
Total 621 264 187 159 760 1,991
TOTAL 160,228 68,253 47,246 41,148 167,286 484,161
NORTHWEST
35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL
< 21 Yrs Female 26,152 6,610 3,962 4,832 41,556
Male 27,637 6,962 4,046 5,010 43,655
Total 53,789 13,572 8,008 9,842 85,211
22-45 Yrs Female 20,238 5,212 3,592 3,550 32,592
Male 11,954 3,413 2,765 2,554 20,686
Total 32,192 8,625 6,357 6,104 53,278
46-64 Yrs Female 8,844 2,008 1,442 1,425 13,719
Male 6,346 1,673 1,430 1,211 10,660
Total 15,190 3,681 2,872 2,636 24,379
Over 64
Yrs
Female 110 21 25 17 173
Male 75 16 9 10 110
Total 185 37 34 27 283
TOTAL 101,356 25,915 17,271 18,609 163,151
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
31
Mandatory October 2016 PLAN MAKE UP BY AGE GROUP AND GENDER
NORTHEAST
41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL
< 21 Yrs Female 21,461 46,955 12,002 80,418
Male 22,621 49,351 12,723 84,695
Total 44,082 96,306 24,725 165,113
22-45 Yrs Female 17,530 36,155 8,902 62,587
Male 10,110 20,170 6,297 36,577
Total 27,640 56,325 15,199 99,164
46-64 Yrs Female 6,993 15,752 3,509 26,254
Male 5,338 11,620 2,873 19,831
Total 12,331 27,372 6,382 46,085
Over 64 Yrs Female 148 263 83 494
Male 67 170 45 282
Total 215 433 128 776
TOTAL 84,268 180,436 46,434 311,138
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16 32
Mandatory October 2016 PLAN MAKE UP BY AGE GROUP
SOUTHEAST
42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL
< 21 Yrs 46,071 38,011 120,144 232,880 437,106
22-45 Yrs 28,855 26,092 79,011 119,368 253,326
46-64 Yrs 13,436 9,965 42,992 61,408 127,801
Over 64 Yrs 590 408 1,400 2,286 4,684
TOTAL 88,952 74,476 243,547 415,942 822,917
SOUTHWEST
31 Gateway 32 United 34 UPMC 59 Aetna TOTAL
< 21 Yrs 68,036 34,958 127,407 9,384 239,785
22-45 Yrs 38,046 20,510 85,614 8,724 152,894
46-64 Yrs 19,011 9,339 45,617 3,617 77,584
Over 64 Yrs 273 145 710 53 1,181
TOTAL 125,366 64,952 259,348 21,778 471,444
LEHIGH/CAPITAL
51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL
< 21 Yrs 95,252 40,215 24,182 20,239 96,022 275,910
22-45 Yrs 45,405 19,753 16,417 14,698 48,692 144,965
46-64 Yrs 18,950 8,021 6,460 6,052 21,812 61,295
Over 64 Yrs 621 264 187 159 760 1,991
TOTAL 160,228 68,253 47,246 41,148 167,286 484,161
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
33
Mandatory October 2016 PLAN MAKE UP BY AGE GROUP
NORTHWEST
35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL
< 21 Yrs 53,789 13,572 8,008 9,842 85,211
22-45 Yrs 32,192 8,625 6,357 6,104 53,278
46-64 Yrs 15,190 3,681 2,872 2,636 24,379
Over 64 Yrs 185 37 34 27 283
TOTAL 101,356 25,915 17,271 18,609 163,151
NORTHEAST
41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL
< 21 Yrs 44,082 96,306 24,725 165,113
22-45 Yrs 27,640 56,325 15,199 99,164
46-64 Yrs 12,331 27,372 6,382 46,085
Over 64 Yrs 215 433 128 776
TOTAL 84,268 180,436 46,434 311,138
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 11/10/16
34
HealthChoices Enrollment 1st Quarter 2016 AID CATEGORY DISTRIBUTION
Southeast
Newly Eligible (19-20)
2%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 24%
SSI & HH 19%
TANF/HB/MAGI (Ages 0-20)
44%
B&CC <1%
Southwest B&CC <1%
Newly Eligible (19-20)
3%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 25%
SSI & HH 20%
TANF/HB/MAGI (Ages 0-20)
41%
Lehigh/Capital B&CC <1%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 24%
SSI & HH 16%
TANF/HB/MAGI (Ages 0-20)
47%
Newly Eligible (19-20)
2%
Northeast B&CC <1%
Newly Eligible (19-20)
3%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 25%
SSI & HH 17%
TANF/HB/MAGI (Ages 0-20)
44%
Northwest B&CC <1%
Newly Eligible (19-20)
3% 35
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 24%
SSI & HH 20%
TANF/HB/MAGI (Ages 0-20)
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 October 2016 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.
October 2016
Zone Percentage
Southeast 93.8%
Southwest 94.6%
Lehigh/Capital 93.5%
Northwest 95.0%
Northeast 93.5%
Total 93.9%
Source: Maximus
36
Medical Assistance Transportation Program
Based on Data Submitted by Each County
37
MATP 4Q FY 14/15
Southeast
COUNTY Total Expenditure Para Transit Trips Mass Transit Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Bucks $ 586,793 20,603 - 12,096 32,699 6.6%
Chester $ 566,831 15,944 1,884 2,310 20,138 8.3%
Delaware $ 1,309,706 34,490 - 11,796 46,286 4.3%
Montgomery $ 629,167 21,004 - 7,251 28,255 7.5%
Philadelphia $ 9,560,604 284,893 835,468 17,552 1,137,913 2.0%
HC-SE Zone $ 12,653,101 376,934 837,352 51,005 1,265,291 5.7%
38
MATP 4Q FY 14/15
Southwest
COUNTY Total Expenditure Para Transit Trips Mass Transit Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Allegheny $ 2,026,576 48,432 137,994 33,333 219,759 6.7%
Armstrong $ 467,523 10,720 - 6,550 17,270 7.9%
Beaver $ 442,233 11,250 314 21,698 33,262 4.4%
Bedford $ 119,716 10,797 - 5,309 16,106 4.9%
Blair $ 244,883 12,243 1,957 4,928 19,128 7.7%
Butler $ 574,807 14,651 - 2,544 17,195 9.6%
Cambria $ 879,835 27,756 4,525 4,274 36,555 8.0%
Fayette $ 294,768 15,199 322 15,035 30,556 5.8%
Greene $ 161,470 4,940 - 2,601 7,541 9.0%
Indiana $ 298,475 7,952 414 5,632 13,998 8.3%
Lawrence $ 244,172 7,349 322 15,361 23,032 5.4%
Somerset $ 218,953 5,166 - 7,868 13,034 7.1%
Washington $ 550,995 20,196 682 14,254 35,132 6.6%
Westmoreland $ 495,833 17,443 196 18,141 35,780 7.3%
HC-SW Zone $ 7,020,239 214,094 146,726 157,528 518,348 7.1%
39
MATP 4Q FY 14/15
Lehigh/Capital
COUNTY Total Expenditure Para Transit Trips Mass Transit Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Berks $ 555,323 21,742 12,652 5,544 39,938 9.3%
Cumberland $ 101,421 5,163 340 2,162 7,665 9.4%
Dauphin $ 707,287 26,128 6,851 1,848 34,827 16.4%
Franklin $ 142,623 4,204 - 2,250 6,454 12.3%
Fulton $ 106,868 1,870 - 1,523 3,393 11.7%
Huntingdon $ 176,860 4,518 - 6,269 10,787 8.3%
Lancaster $ 541,084 20,730 618 5,845 27,193 7.6%
Lebanon $ 340,733 17,127 194 1,676 18,997 7.8%
Lehigh $ 689,230 25,696 - 15,282 40,978 3.0%
Northampton $ 512,912 17,717 - 17,911 35,628 2.6%
Perry $ 85,161 2,158 - 1,507 3,665 11.5%
York/Adams $ 302,631 8,896 914 5,496 15,306 8.7%
HC-L/C Zone $ 4,262,133 155,949 21,569 67,313 244,831 9.1%
40
MATP 4Q FY 14/15
Northwest
COUNTY Total
Expenditure
Para Transit
Trips
Mass Transit
Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Cameron $ 25,082 446 10 279 735 9.7%
Clarion $ 146,480 2,913 - 1,996 4,909 10.2%
Clearfield $ 243,626 7,142 - 7,158 14,300 8.4%
Crawford $ 312,825 4,943 1,503 15,848 22,294 7.4%
Elk $ 88,858 2,822 2 984 3,808 8.2%
Erie $ 547,811 23,337 - 4,461 27,798 5.7%
Forest $ 18,160 528 - 277 805 6.8%
Jefferson $ 598,081 17,921 - 5,774 23,695 6.2%
McKean $ 120,806 2,249 41 647 2,937 14.5%
Mercer $ 185,658 8,571 10 3,480 12,061 9.5%
Potter $ 55,579 1,471 - 1,672 3,143 14.3%
Venango $ 287,933 5,666 425 1,659 7,750 15.0%
Warren $ 73,896 1,694 96 2,441 4,231 15.5%
HC-Northwest Zone $ 2,704,795 79,703 2,087 46,676 128,466 10.1%
41
MATP 4Q FY 14/15
Northeast
COUNTY Total
Expenditure
Para Transit
Trips
Mass Transit
Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Bradford/Tioga $ 248,886 6,172 167 1,706 8,045 10.1%
Carbon $ 273,190 6,761 - 2,582 9,343 5.5%
Centre $ 101,220 4,683 - 2,098 6,781 10.5%
Clinton $ 155,706 3,095 - 512 3,607 13.0%
Columbia $ 137,901 4,955 - 3,851 8,806 8.0%
Juniata $ 32,692 925 - 458 1,383 8.2%
Lackawanna $ 222,686 7,803 3,149 5,982 16,934 4.9%
Luzerne $ 293,461 14,914 1,148 7,682 23,744 13.7%
Lycoming $ 446,639 10,619 1,952 4,259 16,830 10.5%
Mifflin $ 94,115 4,346 - 1,249 5,595 10.7%
Monroe $ 198,370 5,930 1,401 4,170 11,501 9.1%
Montour $ 48,969 1,774 - 788 2,562 9.7%
Northumberland $ 151,404 8,062 - 3,227 11,289 9.1%
Pike $ 60,518 1,355 - 2,098 3,453 7.1%
Schuylkill $ 213,598 4,610 1,165 2,948 8,723 10.5%
Snyder $ 69,818 2,274 - 790 3,064 11.7%
Sullivan $ 19,607 347 37 120 504 7.3%
Susquehanna $ 121,062 2,376 - 1,364 3,740 10.8%
Union $ 44,323 1,554 - 603 2,157 15.3%
Wayne $ 124,885 3,625 - 1,592 5,217 11.8%
Wyoming $ 34,816 775 - 490 1,265 9.7%
HC-Northeast Zone $ 3,093,866 96,955 9,019 48,569 154,543 9.9%
42
Useful Information
To view a complete Pennsylvania Medicaid Managed Care Organization Directory use this link, http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/manage dcareinformation/index.htm, and choose the most current Directory.
43