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: June 30, 2017
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 May 201 7 ENROLLMENT BY PLAN AND BY COUNTY
SOUTHEAST
County 42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL
09 Bucks 5,438 7,177 11,580 39,196 63,391
15 Chester 12,568 7,100 2,684 21,877 44,229
23 Delaware 9,139 11,424 8,620 68,824 98,007
46 Montgomery 9,355 11,384 12,127 53,488 86,354
51 Philadelphia 53,814 36,577 212,934 242,195 545,520
TOTAL 90,314 73,662 247,945 425,580 837,501
PERCENTAGE 11% 9% 30% 51%
SOUTHWEST
County 31 Gateway 32 United 34 UPMC 59 Aetna TOTAL
02 Allegheny 59,416 19,754 99,379 7,179 185,728
03 Armstrong 1,130 526 10,262 437 12,355
04 Beaver 11,717 2,197 13,187 1,277 28,378
05 Bedford 740 1,104 6,102 755 8,701
07 Blair 6,535 3,800 13,119 2,146 25,600
10 Butler 5,569 1,049 14,053 904 21,575
11 Cambria 3,817 5,204 14,917 2,773 26,711
26 Fayette 4,198 9,501 19,580 782 34,061
30 Greene 858 3,540 3,250 386 8,034
32 Indiana 2,599 1,833 8,973 588 13,993
37 Lawrence 7,266 1,407 8,458 769 17,900
56 Somerset 1,894 2,896 6,399 1,056 12,245
63 Washington 5,895 5,010 18,453 1,351 30,709
65 Westmoreland 11,566 7,834 31,594 2,076 53,070
TOTAL 123,200 65,655 267,726 22,479 479,060
PERCENTAGE 25% 14% 56% 5%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
5
Mandatory May 201 7 ENROLLMENT BY PLAN AND BY COUNTY
cont. LEHIGH/CAPITAL
County 51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL
01 Adams 4,088 4,707 1,176 1,203 1,468 12,642
06 Berks 15,394 8,953 6,407 6,889 40,313 77,956
21 Cumberland 12,366 3,652 3,916 1,418 5,030 26,382
22 Dauphin 28,303 10,037 7,303 3,900 5,750 55,293
28 Franklin 935 696 8,018 423 12,718 22,790
29 Fulton 147 300 731 595 719 2,492
31 Huntingdon 511 688 965 3,740 1,590 7,494
36 Lancaster 23,472 10,371 3,669 8,868 28,992 75,372
38 Lebanon 14,199 1,780 1,796 1,899 3,127 22,801
39 Lehigh 21,858 4,747 3,094 4,920 35,004 69,623
48 Northampton 13,324 2,698 2,535 2,521 23,380 44,458
50 Perry 3,674 632 643 256 923 6,128
67 York 21,853 21,242 7,017 6,542 13,765 70,419
TOTAL 160,124 70,503 47,270 43,174 172,779 493,850
PERCENTAGE 32% 14% 10% 9% 35%
NORTHWEST
County 35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL
12 Cameron 855 39 129 39 1,062
16 Clarion 4,054 866 588 646 6,154
17 Clearfield 10,610 1,374 2,037 1,760 15,781
20 Crawford 12,104 1,001 1,132 1,254 15,491
24 Elk 3,543 456 266 275 4,540
25 Erie 32,176 14,688 5,954 9,851 62,669
27 Forest 528 97 74 49 748
33 Jefferson 6,812 983 356 441 8,592
42 McKean 6,222 289 1,239 754 8,504
43 Mercer 13,824 3,857 2,219 2,170 22,070
53 Potter 1,903 31 1,409 69 3,412
61 Venango 7,302 908 1,106 1,118 10,434
62 Warren 4,728 668 768 510 6,674
TOTAL 104,661 25,257 17,277 18,936 166,131
PERCENTAGE 63% 15% 10% 11%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
6
Mandatory May 201 7 ENROLLMENT BY PLAN AND BY COUNTY
cont.
NORTHEAST
County 41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL
08 Bradford 2,859 4,644 3,521 11,024
13 Carbon 7,014 2,732 1,150 10,896
14 Centre 2,575 6,423 2,594 11,592
18 Clinton 1,151 5,131 794 7,076
19 Columbia 1,507 7,134 1,171 9,812
34 Juniata 759 1,712 691 3,162
35 Lackawanna 6,996 29,953 5,518 42,467
40 Luzerne 16,957 43,480 9,573 70,010
41 Lycoming 4,951 15,196 1,521 21,668
44 Mifflin 2,077 4,680 1,633 8,390
45 Monroe 13,949 12,778 4,666 31,393
47 Montour 353 1,619 315 2,287
49 Northumberland 3,121 10,384 3,548 17,053
52 Pike 2,646 5,132 1,240 9,018
54 Schuylkill 8,449 14,937 3,184 26,570
55 Snyder 1,064 3,014 948 5,026
57 Sullivan 166 510 154 830
58 Susquehanna 1,118 4,619 943 6,680
59 Tioga 6,026 988 596 7,610
60 Union 922 2,750 751 4,423
64 Wayne 1,593 5,664 1,096 8,353
66 Wyoming 763 3,370 655 4,788
TOTAL 87,016 186,850 46,262 320,128
PERCENTAGE 27% 59% 14%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
7
Mandatory May 201 7 MARKET SHARE BY PLAN – STATEWIDE
Total Enrollment = 2,296,670
AmeriHealth NE 87,016
4% Aetna
208,609 9%
AmeriHealth 190,056
8%
Gateway 308,581
13%
Health Partners 247,945
11%
Keystone 425,580
19%
United 226,472
10%
UPMC 415,561
18%
Geisinger 186,850
8%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17 8
Mandatory May 201 7 MARKET SHARE BY ZONE AND BY PLAN
Northwest
Aetna 18,936
11%
Gateway 25,257
15%
UPMC 104,661
63%
Ameri-Health 17,277
11%
Southeast
Aetna 73,662
9%
Health Partners 247,945
29%
Keystone 425,580
51%
United 90,314
11%
Southwest Aetna 22,479
4%
Gateway 123,200
26%
United 65,655
14%
UPMC 267,726
56%
Lehigh/Capital
Aetna 47,270
10%
Ameri-Health
172,779 35%
Gateway 160,124
32%
United 70,503
14%
UPMC 43,174
9%
Northeast
Aetna 46,262
15%
Ameri-Health NE
87,016 27%
Geisinger 186,850
58%
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
9
Mandatory May 201 7 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 618 2,482 4,657 2,157 34,342 44,256
43 Aetna 637 1,238 5,133 2,427 22,715 32,150
45 Health Partners 1,318 441 4,593 3,608 104,590 114,550
47 Keystone 3,978 3,895 33,186 12,265 149,470 202,794
Southeast MCOs 6,551 8,056 47,569 20,457 311,117 393,750
American Indian or
Alaskan Native
42 United 12 38 21 28 63 162
43 Aetna 24 40 9 55 59 187
45 Health Partners 37 13 7 39 234 330
47 Keystone 86 83 112 139 288 708
Southeast MCOs 159 174 149 261 644 1,387
Asian
42 United 227 255 624 534 3,904 5,544
43 Aetna 294 171 546 763 1,590 3,364
45 Health Partners 584 71 423 679 7,622 9,379
47 Keystone 1,346 599 4,128 3,544 18,301 27,918
Southeast MCOs 2,451 1,096 5,721 5,520 31,417 46,205
White
42 United 3,751 6,968 2,957 4,786 7,728 26,190
43 Aetna 5,325 4,517 4,710 6,361 7,045 27,958
45 Health Partners 7,686 1,748 2,554 5,780 34,251 52,019
47 Keystone 28,573 13,515 25,518 28,482 40,719 136,807
Southeast MCOs 45,335 26,748 35,739 45,409 89,743 242,974
Other or system default
42 United 531 2,101 552 1,261 6,237 10,682
43 Aetna 496 764 614 1,060 3,971 6,905
45 Health Partners 1,401 231 728 1,420 61,818 65,598
47 Keystone 3,850 2,886 4,353 6,847 28,196 46,132
Southeast MCOs 6,278 5,982 6,247 10,588 100,222 129,317
Native Hawaiian or Other
Pacific Islander
42 United 3 10 8 6 46 73
43 Aetna 5 9 12 17 30 73
45 Health Partners 20 1 7 6 135 169
47 Keystone 33 19 43 49 122 266
Southeast MCOs 61 39 70 78 333 581
Unknown
42 United 296 714 320 583 1,494 3,407
43 Aetna 396 361 400 701 1,167 3,025
45 Health Partners 534 179 308 595 4,284 5,900
47 Keystone 1,330 880 1,484 2,162 5,099 10,955
Southeast MCOs 2,556 2,134 2,512 4,041 12,044 23,287
MCO TOTAL
42 United 5,438 12,568 9,139 9,355 53,814 90,314
43 Aetna 7,177 7,100 11,424 11,384 36,577 73,662
45 Health Partners 11,580 2,684 8,620 12,127 212,934 247,945
47 Keystone 39,196 21,877 68,824 53,488 242,195 425,580
TOTAL 63,391 44,229 98,007 86,354 545,520 837,501
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
10
Mandatory May 201 7 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 28,392 31 2,773 17 454 222 483 392
32 United 8,044 10 409 13 238 29 857 875
34 UPMC 32,837 153 2,087 66 552 324 1,252 1,534
59 Aetna 2,548 5 253 13 129 19 719 79
Southwest MCOs 71,821 199 5,522 109 1,373 594 3,311 2,880
American Indian or
Alaskan Native
31 Gateway 123 2 12 0 6 4 10 8
32 United 52 2 0 1 7 1 3 9
34 UPMC 296 16 31 11 23 23 24 26
59 Aetna 21 0 3 0 5 0 3 3
Southwest MCOs 492 20 46 12 41 28 40 46
Asian
31 Gateway 840 1 29 0 18 26 5 21
32 United 403 2 16 3 24 22 13 16
34 UPMC 4,832 27 127 26 56 151 48 55
59 Aetna 181 0 16 3 11 4 11 1
Southwest MCOs 6,256 30 188 32 109 203 77 93
White
31 Gateway 27,273 1,082 8,633 703 5,967 5,187 3,230 3,691
32 United 9,976 501 1,679 1,073 3,462 941 4,190 8,430
34 UPMC 54,550 9,963 10,489 5,885 12,257 13,070 13,271 17,581
59 Aetna 3,782 427 949 730 1,958 845 1,978 668
Southwest MCOs 95,581 11,973 21,750 8,391 23,644 20,043 22,669 30,370
Other or system
default
31 Gateway 1,691 9 202 12 55 71 61 43
32 United 701 4 63 10 34 19 94 104
34 UPMC 3,768 49 257 88 112 234 182 145
59 Aetna 264 1 33 5 19 15 38 8
Southwest MCOs 6,424 63 555 115 220 339 375 300
Native Hawaiian or
Other Pacific Islander
31 Gateway 14 0 6 0 1 2 0 2
32 United 13 0 0 0 1 1 2 0
34 UPMC 64 0 3 5 6 3 2 15
59 Aetna 4 0 1 0 1 0 1 0
Southwest MCOs 95 0 10 5 9 6 5 17
Unknown
31 Gateway 1,083 5 62 8 34 57 28 41
32 United 565 7 30 4 34 36 45 67
34 UPMC 3,032 54 193 21 113 248 138 224
59 Aetna 379 4 22 4 23 21 23 23
Southwest MCOs 5,059 70 307 37 204 362 234 355
MCO TOTAL
31 Gateway 59,416 1,130 8,944 740 6,535 5,569 3,817 4,198
32 United 19,754 526 2,197 1,104 3,800 1,049 5,204 9,501
34 UPMC 99,379 10,262 13,187 6,102 13,119 14,053 14,917 19,580
59 Aetna 7,179 437 1,277 755 2,146 904 2,773 782
TOTAL 185,728 12,355 28,378 8,701 25,600 21,575 26,711 34,061
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
11
Mandatory May 201 7 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 16 95 960 17 694 1,471 36,017
32 United 37 91 194 24 555 777 12,153
34 UPMC 44 251 869 55 1,622 2,118 43,764
59 Aetna 9 44 133 20 157 169 4,297
Southwest MCOs 106 481 2,156 116 3,028 4,535 96,231
American Indian or
Alaskan Native
31 Gateway 3 2 7 2 6 24 209
32 United 4 4 1 2 10 16 112
34 UPMC 5 9 13 13 32 52 574
59 Aetna 1 2 2 2 3 3 48
Southwest MCOs 13 17 23 19 51 95 943
Asian
31 Gateway 2 26 15 5 22 35 1,045
32 United 4 4 3 3 14 33 560
34 UPMC 10 67 39 20 115 224 5,797
59 Aetna 4 6 2 2 6 21 268
Southwest MCOs 20 103 59 30 157 313 7,670
White
31 Gateway 826 2,415 6,193 1,837 5,018 9,731 81,786
32 United 3,475 1,692 1,181 2,829 4,272 6,742 50,443
34 UPMC 3,145 8,443 7,394 6,208 16,029 28,114 206,399
59 Aetna 363 507 616 1,000 1,117 1,791 16,731
Southwest MCOs 7,809 13,057 15,384 11,874 26,436 46,378 355,359
Other or system
default
31 Gateway 8 33 40 22 70 164 2,481
32 United 11 18 18 20 78 135 1,309
34 UPMC 25 88 67 39 264 436 5,754
59 Aetna 3 15 8 12 18 40 479
Southwest MCOs 47 154 133 93 430 775 10,023
Native Hawaiian or
Other Pacific Islander
31 Gateway 0 0 1 1 0 3 30
32 United 0 1 1 0 4 2 25
34 UPMC 3 3 2 0 8 9 123
59 Aetna 0 0 0 0 0 1 8
Southwest MCOs 3 4 4 1 12 15 186
Unknown
31 Gateway 3 28 50 10 85 138 1,632
32 United 9 23 9 18 77 129 1,053
34 UPMC 18 112 74 64 383 641 5,315
59 Aetna 6 14 8 20 50 51 648
Southwest MCOs 36 177 141 112 595 959 8,648
MCO TOTAL
31 Gateway 858 2,599 7,266 1,894 5,895 11,566 123,200
32 United 3,540 1,833 1,407 2,896 5,010 7,834 65,655
34 UPMC 3,250 8,973 8,458 6,399 18,453 31,594 267,726
59 Aetna 386 588 769 1,056 1,351 2,076 22,479
TOTAL 8,034 13,993 17,900 12,245 30,709 53,070 479,060
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
12
Mandatory May 201 7 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 147 1,455 1,424 11,082 80 2 24
52 United 241 793 481 3,707 54 6 29
53 Aetna 57 721 392 2,305 684 14 50
54 UPMC 48 588 117 1,159 43 6 115
57 AmeriHealth 77 3,437 513 1,770 1,082 17 47
Lehigh/Capital MCOs 570 6,994 2,927 20,023 1,943 45 265
American Indian or
Alaskan Native
51 Gateway 18 18 34 75 4 1 0
52 United 12 16 12 26 2 0 0
53 Aetna 7 10 10 30 14 2 0
54 UPMC 1 13 3 8 3 2 8
57 AmeriHealth 2 43 8 24 34 3 1
Lehigh/Capital MCOs 40 100 67 163 57 8 9
Asian
51 Gateway 32 176 323 1,425 10 0 1
52 United 39 142 135 471 2 0 1
53 Aetna 5 126 122 272 47 1 4
54 UPMC 14 68 37 166 2 1 15
57 AmeriHealth 10 299 113 170 104 0 3
Lehigh/Capital MCOs 100 811 730 2,504 165 2 24
White
51 Gateway 3,584 7,220 8,875 8,800 728 140 472
52 United 3,716 5,141 2,418 3,647 578 291 643
53 Aetna 979 3,829 2,887 3,426 6,400 698 899
54 UPMC 1,010 4,096 1,055 1,877 341 585 3,531
57 AmeriHealth 1,251 13,851 3,753 2,391 9,434 682 1,513
Lehigh/Capital MCOs 10,540 34,137 18,988 20,141 17,481 2,396 7,058
Other or system
default
51 Gateway 198 6,145 1,268 5,897 76 0 13
52 United 551 2,560 429 1,726 39 3 11
53 Aetna 79 1,474 289 915 588 13 8
54 UPMC 74 1,831 142 488 12 0 49
57 AmeriHealth 76 21,671 432 1,053 1,407 13 15
Lehigh/Capital MCOs 978 33,681 2,560 10,079 2,122 29 96
Native Hawaiian or
Other Pacific Islander
51 Gateway 2 3 9 23 0 0 0
52 United 2 13 3 10 1 0 0
53 Aetna 1 3 9 6 7 0 0
54 UPMC 1 5 4 3 2 1 1
57 AmeriHealth 0 24 6 8 11 1 2
Lehigh/Capital MCOs 6 48 31 50 21 2 3
Unknown
51 Gateway 107 377 433 1,001 37 4 1
52 United 146 288 174 450 20 0 4
53 Aetna 48 244 207 349 278 3 4
54 UPMC 55 288 60 199 20 0 21
57 AmeriHealth 52 988 205 334 646 3 9
Lehigh/Capital MCOs 408 2,185 1,079 2,333 1,001 10 39
MCO TOTAL
51 Gateway 4,088 15,394 12,366 28,303 935 147 511
52 United 4,707 8,953 3,652 10,037 696 300 688
53 Aetna 1,176 6,407 3,916 7,303 8,018 731 965
54 UPMC 1,203 6,889 1,418 3,900 423 595 3,740
57 AmeriHealth 1,468 40,313 5,030 5,750 12,718 719 1,590
TOTAL 12,642 77,956 26,382 55,293 22,790 2,492 7,494
Racial/Ethnic
information is self-
reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
13
Mandatory May 201 7 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 1,958 613 3,043 1,910 44 2,449 24,231
52 United 1,251 113 715 332 12 3,861 11,595
53 Aetna 420 78 525 349 24 1,085 6,704
54 UPMC 793 135 690 280 7 898 4,879
57 AmeriHealth 3,259 182 3,956 2,500 13 2,222 19,075
Lehigh/Capital MCOs 7,681 1,121 8,929 5,371 100 10,515 66,484
American Indian or
Alaskan Native
51 Gateway 35 13 34 35 2 72 341
52 United 25 1 18 5 0 50 167
53 Aetna 18 2 3 14 1 28 139
54 UPMC 34 7 10 7 2 20 118
57 AmeriHealth 52 4 46 52 0 54 323
Lehigh/Capital MCOs 164 27 111 113 5 224 1,088
Asian
51 Gateway 978 116 315 212 9 208 3,805
52 United 284 23 111 58 2 247 1,515
53 Aetna 109 17 81 63 6 110 963
54 UPMC 293 15 157 67 1 84 920
57 AmeriHealth 701 59 599 466 1 166 2,691
Lehigh/Capital MCOs 2,365 230 1,263 866 19 815 9,894
White
51 Gateway 15,001 9,692 15,336 7,768 3,509 15,922 97,047
52 United 5,872 1,276 3,206 1,821 587 12,115 41,311
53 Aetna 2,226 1,303 2,075 1,726 588 4,668 31,704
54 UPMC 5,696 1,307 3,366 1,704 229 4,426 29,223
57 AmeriHealth 14,857 1,734 25,670 15,064 872 8,301 99,373
Lehigh/Capital MCOs 43,652 15,312 49,653 28,083 5,785 45,432 298,658
Other or system default
51 Gateway 4,529 3,370 2,720 3,067 80 2,678 30,041
52 United 2,438 305 500 357 16 4,391 13,326
53 Aetna 645 322 301 279 12 837 5,762
54 UPMC 1,447 350 498 312 12 847 6,062
57 AmeriHealth 8,697 1,010 4,011 4,686 25 2,547 45,643
Lehigh/Capital MCOs 17,756 5,357 8,030 8,701 145 11,300 100,834
Native Hawaiian or
Other Pacific Islander
51 Gateway 8 8 12 9 0 17 91
52 United 10 2 21 5 1 20 88
53 Aetna 4 1 5 4 0 5 45
54 UPMC 5 1 14 13 0 4 54
57 AmeriHealth 26 5 29 20 0 17 149
Lehigh/Capital MCOs 53 17 81 51 1 63 427
Unknown
51 Gateway 963 387 398 323 30 507 4,568
52 United 491 60 176 120 14 558 2,501
53 Aetna 247 73 104 100 12 284 1,953
54 UPMC 600 84 185 138 5 263 1,918
57 AmeriHealth 1,400 133 693 592 12 458 5,525
Lehigh/Capital MCOs 3,701 737 1,556 1,273 73 2,070 16,465
MCO TOTAL
51 Gateway 23,472 14,199 21,858 13,324 3,674 21,853 160,124
52 United 10,371 1,780 4,747 2,698 632 21,242 70,503
53 Aetna 3,669 1,796 3,094 2,535 643 7,017 47,270
54 UPMC 8,868 1,899 4,920 2,521 256 6,542 43,174
57 AmeriHealth 28,992 3,127 35,004 23,380 923 13,765 172,779
TOTAL 75,372 22,801 69,623 44,458 6,128 70,419 493,850
Racial/Ethnic information is
self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
14
Mandatory May 201 7 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 20 77 111 408 37 4,927 2
36 Gateway 0 17 33 36 6 3,679 1
37 AmeriHealth 7 16 31 30 5 1,324 0
56 Aetna 0 32 19 48 2 2,377 1
New West MCOs 27 142 194 522 50 12,307 4
American Indian or Alaskan
Native
35 UPMC 1 3 7 19 12 96 2
36 Gateway 0 1 0 2 0 34 4
37 AmeriHealth 0 2 6 2 1 11 0
56 Aetna 1 2 0 4 0 45 1
New West MCOs 2 8 13 27 13 186 7
Asian
35 UPMC 8 10 45 37 6 1,435 0
36 Gateway 0 5 2 0 2 241 0
37 AmeriHealth 2 3 10 2 0 175 0
56 Aetna 0 2 7 2 0 111 0
New West MCOs 10 20 64 41 8 1,962 0
White
35 UPMC 819 3,895 10,337 11,473 3,458 23,770 519
36 Gateway 39 830 1,323 946 446 9,690 92
37 AmeriHealth 119 557 1,963 1,075 258 4,096 74
56 Aetna 38 603 1,706 1,186 268 6,672 46
New West MCOs 1,015 5,885 15,329 14,680 4,430 44,228 731
Other or system default
35 UPMC 5 21 52 80 15 1,564 4
36 Gateway 0 6 9 7 1 916 0
37 AmeriHealth 1 5 10 11 1 285 0
56 Aetna 0 2 10 3 3 550 1
New West MCOs 6 34 81 101 20 3,315 5
Native Hawaiian or Other
Pacific Islander
35 UPMC 0 1 0 1 0 19 0
36 Gateway 0 0 0 3 0 7 0
37 AmeriHealth 0 0 0 0 0 2 0
56 Aetna 0 1 1 2 0 4 0
New West MCOs 0 2 1 6 0 32 0
Unknown
35 UPMC 2 47 58 86 15 365 1
36 Gateway 0 7 7 7 1 121 0
37 AmeriHealth 0 5 17 12 1 61 0
56 Aetna 0 4 17 9 2 92 0
New West MCOs 2 63 99 114 19 639 1
MCO TOTAL
35 UPMC 855 4,054 10,610 12,104 3,543 32,176 528
36 Gateway 39 866 1,374 1,001 456 14,688 97
37 AmeriHealth 129 588 2,037 1,132 266 5,954 74
56 Aetna 39 646 1,760 1,254 275 9,851 49
TOTAL 1,062 6,154 15,781 15,491 4,540 62,669 748
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
15
Mandatory May 201 7 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 69 60 1,761 15 194 37 7,718
36 Gateway 8 8 695 0 30 6 4,519
37 AmeriHealth 7 4 449 15 31 7 1,926
56 Aetna 5 6 431 0 37 6 2,964
New West MCOs 89 78 3,336 30 292 56 17,127
American Indian or
Alaskan Native
35 UPMC 6 19 13 5 11 16 210
36 Gateway 1 2 4 0 6 1 55
37 AmeriHealth 1 5 5 1 3 0 37
56 Aetna 3 4 4 0 2 3 69
New West MCOs 11 30 26 6 22 20 371
Asian
35 UPMC 14 17 86 1 23 13 1,695
36 Gateway 2 0 18 0 4 0 274
37 AmeriHealth 1 11 12 1 5 2 224
56 Aetna 0 1 13 0 1 2 139
New West MCOs 17 29 129 2 33 17 2,332
White
35 UPMC 6,671 6,072 11,627 1,858 6,979 4,618 92,096
36 Gateway 968 276 3,067 31 848 655 19,211
37 AmeriHealth 343 1,204 1,687 1,377 1,054 754 14,561
56 Aetna 427 740 1,666 68 1,061 490 14,971
New West MCOs 8,409 8,292 18,047 3,334 9,942 6,517 140,839
Other or system default
35 UPMC 27 35 173 10 50 25 2,061
36 Gateway 4 3 36 0 10 1 993
37 AmeriHealth 2 9 34 9 8 2 377
56 Aetna 3 2 23 0 11 6 614
New West MCOs 36 49 266 19 79 34 4,045
Native Hawaiian or Other
Pacific Islander
35 UPMC 1 3 4 1 2 1 33
36 Gateway 0 0 2 0 1 0 13
37 AmeriHealth 0 2 1 1 1 1 8
56 Aetna 0 0 0 0 0 0 8
New West MCOs 1 5 7 2 4 2 62
Unknown
35 UPMC 24 16 160 13 43 18 848
36 Gateway 0 0 35 0 9 5 192
37 AmeriHealth 2 4 31 5 4 2 144
56 Aetna 3 1 33 1 6 3 171
New West MCOs 29 21 259 19 62 28 1,355
MCO TOTAL
35 UPMC 6,812 6,222 13,824 1,903 7,302 4,728 104,661
36 Gateway 983 289 3,857 31 908 668 25,257
37 AmeriHealth 356 1,239 2,219 1,409 1,106 768 17,277
56 Aetna 441 754 2,170 69 1,118 510 18,936
TOTAL 8,592 8,504 22,070 3,412 10,434 6,674 166,131
Racial/Ethnic information is self-reported by consumers. Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
16
Mandatory May 201 7 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 42 197 123 16 76 12 791 1,896
44 Geisinger 62 87 243 79 222 24 2,381 4,276
50 Aetna 55 71 153 36 74 10 634 1,293
New East MCOs 159 355 519 131 372 46 3,806 7,465
American Indian or Alaskan
Native
41 AmeriHealth NE 9 11 5 2 7 3 13 31
44 Geisinger 5 6 25 6 12 4 62 49
50 Aetna 3 4 14 0 4 1 7 11
New East MCOs 17 21 44 8 23 8 82 91
Asian
41 AmeriHealth NE 16 15 65 6 8 1 191 111
44 Geisinger 26 14 155 14 46 7 991 380
50 Aetna 6 5 103 1 15 4 205 82
New East MCOs 48 34 323 21 69 12 1,387 573
White
41 AmeriHealth NE 2,748 6,470 2,287 1,105 1,356 673 4,925 9,973
44 Geisinger 4,499 2,482 5,815 4,920 6,673 1,534 22,209 30,750
50 Aetna 3,415 1,000 2,204 731 1,028 625 3,909 6,333
New East MCOs 10,662 9,952 10,306 6,756 9,057 2,832 31,043 47,056
Other or system default
41 AmeriHealth NE 21 225 57 12 42 55 939 4,698
44 Geisinger 25 95 81 54 109 123 3,727 7,385
50 Aetna 19 44 54 9 32 42 620 1,691
New East MCOs 65 364 192 75 183 220 5,286 13,774
Native Hawaiian or Other
Pacific Islander
41 AmeriHealth NE 1 0 1 0 1 0 2 6
44 Geisinger 0 0 2 0 1 0 12 26
50 Aetna 0 1 3 0 1 0 9 7
New East MCOs 1 1 6 0 3 0 23 39
Unknown
41 AmeriHealth NE 22 96 37 10 17 15 135 242
44 Geisinger 27 48 102 58 71 20 571 614
50 Aetna 23 25 63 17 17 9 134 156
New East MCOs 72 169 202 85 105 44 840 1,012
MCO TOTAL
41 AmeriHealth NE 2,859 7,014 2,575 1,151 1,507 759 6,996 16,957
44 Geisinger 4,644 2,732 6,423 5,131 7,134 1,712 29,953 43,480
50 Aetna 3,521 1,150 2,594 794 1,171 691 5,518 9,573
TOTAL 11,024 10,896 11,592 7,076 9,812 3,162 42,467 70,010
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
17
Mandatory May 201 7 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 868 44 2,360 12 169 305 346 40
44 Geisinger 2,123 82 2,324 45 401 344 502 93
50 Aetna 224 38 1,064 14 189 113 126 21
New East MCOs 3,215 164 5,748 71 759 762 974 154
American Indian or
Alaskan Native
41 AmeriHealth NE 6 3 31 0 8 11 12 0
44 Geisinger 30 4 49 5 16 12 21 5
50 Aetna 1 0 14 1 6 8 1 1
New East MCOs 37 7 94 6 30 31 34 6
Asian
41 AmeriHealth NE 15 7 174 4 8 23 40 20
44 Geisinger 73 15 208 17 41 57 73 11
50 Aetna 11 11 59 5 9 6 17 5
New East MCOs 99 33 441 26 58 86 130 36
White
41 AmeriHealth NE 3,952 1,994 8,612 319 2,717 1,955 7,502 977
44 Geisinger 12,711 4,490 7,605 1,496 9,429 4,280 13,592 2,802
50 Aetna 1,243 1,547 2,506 284 3,177 948 2,883 889
New East MCOs 17,906 8,031 18,723 2,099 15,323 7,183 23,977 4,668
Other or system default
41 AmeriHealth NE 70 23 2,293 15 192 294 461 21
44 Geisinger 156 74 2,159 34 358 322 587 64
50 Aetna 19 30 828 5 130 129 123 13
New East MCOs 245 127 5,280 54 680 745 1,171 98
Native Hawaiian or Other
Pacific Islander
41 AmeriHealth NE 4 2 30 0 0 0 1 0
44 Geisinger 6 2 8 3 5 7 10 2
50 Aetna 0 4 5 0 3 0 1 0
New East MCOs 10 8 43 3 8 7 12 2
Unknown
41 AmeriHealth NE 36 4 449 3 27 58 87 6
44 Geisinger 97 13 425 19 134 110 152 37
50 Aetna 23 3 190 6 34 36 33 19
New East MCOs 156 20 1,064 28 195 204 272 62
MCO TOTAL
41 AmeriHealth NE 4,951 2,077 13,949 353 3,121 2,646 8,449 1,064
44 Geisinger 15,196 4,680 12,778 1,619 10,384 5,132 14,937 3,014
50 Aetna 1,521 1,633 4,666 315 3,548 1,240 3,184 948
TOTAL 21,668 8,390 31,393 2,287 17,053 9,018 26,570 5,026
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
18
Mandatory May 201 7 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 3 88 48 43 9 7,489
44 Geisinger 4 30 17 197 103 34 13,673
50 Aetna 5 12 19 45 33 7 4,236
New East MCOs 10 45 124 290 179 50 25,398
American Indian or Alaskan
Native
41 AmeriHealth NE 1 0 13 0 3 0 169
44 Geisinger 1 2 4 4 22 4 348
50 Aetna 0 0 1 1 5 0 83
New East MCOs 2 2 18 5 30 4 600
Asian
41 AmeriHealth NE 1 3 18 3 14 3 746
44 Geisinger 0 15 6 20 30 14 2,213
50 Aetna 0 2 0 0 6 2 554
New East MCOs 1 20 24 23 50 19 3,513
White
41 AmeriHealth NE 158 1,094 5,845 838 1,482 737 67,719
44 Geisinger 501 4,513 934 2,428 5,351 3,272 152,286
50 Aetna 145 920 563 687 1,005 635 36,677
New East MCOs 804 6,527 7,342 3,953 7,838 4,644 256,682
Other or system default
41 AmeriHealth NE 3 15 38 25 35 10 9,544
44 Geisinger 4 29 9 77 97 18 15,587
50 Aetna 2 7 8 10 30 7 3,852
New East MCOs 9 51 55 112 162 35 28,983
Native Hawaiian or Other
Pacific Islander
41 AmeriHealth NE 0 0 2 0 1 1 52
44 Geisinger 0 0 0 0 2 0 86
50 Aetna 0 0 0 0 1 0 35
New East MCOs 0 0 2 0 4 1 173
Unknown
41 AmeriHealth NE 2 3 22 8 15 3 1,297
44 Geisinger 0 30 18 24 59 28 2,657
50 Aetna 2 2 5 8 16 4 825
New East MCOs 4 35 45 40 90 35 4,779
MCO TOTAL
41 AmeriHealth NE 166 1,118 6,026 922 1,593 763 87,016 44 Geisinger 510 4,619 988 2,750 5,664 3,370 186,850 50 Aetna 154 943 596 751 1,096 655 46,262
TOTAL 830 6,680 7,610 4,423 8,353 4,788 320,128
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
19
Mandatory May 201 7 ENROLLMENT BY ETHNICITY, BY PLAN AND BY COUNTY
Southeast
09 Bucks 15 Chester 23 Delaware 46 Montgomery 51 Philadelphia Southeast
Other/Unknown
42 United 45 57 44 58 172 376
43 Aetna 42 31 38 59 135 305
45 Health Partners 40 45 36 62 237 420
47 Keystone 116 47 86 193 340 782
Southeast MCOs 243 180 204 372 884 1,883
Non-Hispanic
42 United 4,833 9,287 8,635 8,067 47,701 78,523
43 Aetna 6,585 5,931 10,824 10,460 32,515 66,315
45 Health Partners 10,022 2,353 7,910 10,820 146,667 177,772
47 Keystone 34,946 17,813 65,144 47,388 215,387 380,678
Southeast MCOs 56,386 35,384 92,513 76,735 442,270 703,288
Hispanic
42 United 560 3,224 460 1,230 5,941 11,415
43 Aetna 550 1,138 562 865 3,927 7,042
45 Health Partners 1,518 286 674 1,245 66,030 69,753
47 Keystone 4,134 4,017 3,594 5,907 26,468 44,120
Southeast MCOs 6,762 8,665 5,290 9,247 102,366 132,330
TOTAL 63,391 44,229 98,007 86,354 545,520 837,501
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
20
Mandatory May 201 7 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 88 1 4 0 11 13 4 7
32 United 74 2 6 1 1 6 8 6
34 UPMC 309 11 17 6 24 35 19 32
59 Aetna 45 4 2 2 4 9 2 1
Southwest MCOs 516 18 29 9 40 63 33 46
Non-Hispanic
31 Gateway 58,510 1,116 11,574 735 6,447 5,452 3,753 4,157
32 United 19,294 523 2,145 1,097 3,747 1,008 5,105 9,409
34 UPMC 96,942 10,186 12,994 6,018 12,946 13,756 14,753 19,381
59 Aetna 6,940 431 1,246 747 2,108 878 2,737 770
Southwest MCOs 181,686 12,256 27,959 8,597 25,248 21,094 26,348 33,717
Hispanic
31 Gateway 818 13 139 5 77 104 60 34
32 United 386 1 46 6 52 35 91 86
34 UPMC 2,128 65 176 78 149 262 145 167
59 Aetna 194 2 29 6 34 17 34 11
Southwest MCOs 3,526 81 390 95 312 418 330 298
TOTAL 185,728 12,355 28,378 8,701 25,600 21,575 26,711 34,061
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
21
Mandatory May 201 7 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 3 2 1 2 11 14 161
32 United 3 12 1 2 4 21 147
34 UPMC 4 22 5 6 32 50 572
59 Aetna 2 4 0 0 9 9 93
Southwest MCOs 12 40 7 10 56 94 973
Non-Hispanic
31 Gateway 849 2,575 7,215 1,870 5,807 11,442 121,502
32 United 3,520 1,798 1,389 2,869 4,932 7,714 64,550
34 UPMC 3,224 8,857 8,353 6,332 18,166 31,201 263,109
59 Aetna 382 564 763 1,040 1,315 2,029 21,950
Southwest MCOs 7,975 13,794 17,720 12,111 30,220 52,386 471,111
Hispanic
31 Gateway 6 22 50 22 77 110 1,537
32 United 17 23 17 25 74 99 958
34 UPMC 22 94 100 61 255 343 4,045
59 Aetna 2 20 6 16 27 38 436
Southwest MCOs 47 159 173 124 433 590 6,976
TOTAL 8,034 13,993 17,900 12,245 30,709 53,070 479,060
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
22
Mandatory May 201 7 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 4 17 28 37 6 4 4
52 United 12 19 18 47 2 0 0
53 Aetna 6 26 24 24 14 0 0
54 UPMC 3 23 9 19 8 1 3
57 AmeriHealth 3 44 24 18 47 1 0
Lehigh/Capital MCOs 28 129 103 145 77 6 7
Non-Hispanic
51 Gateway 3,785 8,406 11,514 22,219 854 141 498
52 United 3,775 6,072 3,289 8,362 649 297 674
53 Aetna 1,041 4,722 3,653 6,455 7,397 715 954
54 UPMC 1,053 4,749 1,311 3,448 398 590 3,703
57 AmeriHealth 1,324 16,083 4,628 4,587 10,822 707 1,581
Lehigh/Capital MCOs 10,978 40,032 24,395 45,071 20,120 2,450 7,410
Hispanic
51 Gateway 299 6,971 824 6,047 75 2 9
52 United 920 2,862 345 1,628 45 3 14
53 Aetna 129 1,659 239 824 607 16 11
54 UPMC 147 2,117 98 433 17 4 34
57 AmeriHealth 141 24,186 378 1,145 1,849 11 9
Lehigh/Capital MCOs 1,636 37,795 1,884 10,077 2,593 36 77
TOTAL 12,642 77,956 26,382 55,293 22,790 2,492 7,494
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
23
Mandatory May 2017 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 37 10 27 27 4 38 243
52 United 23 9 17 14 5 48 214
53 Aetna 13 5 14 21 1 27 175
54 UPMC 55 4 24 22 0 20 191
57 AmeriHealth 64 6 79 57 3 35 381
Lehigh/Capital MCOs 192 34 161 141 13 168 1,204
Non-Hispanic
51 Gateway 18,384 9,386 10,185 8,896 3,571 19,014 116,853
52 United 7,509 1,327 2,712 2,234 610 16,231 53,741
53 Aetna 2,909 1,350 1,953 2,100 629 6,084 39,962
54 UPMC 7,081 1,372 3,207 1,992 247 5,538 34,689
57 AmeriHealth 18,553 1,721 17,862 16,567 903 10,692 106,030
Lehigh/Capital MCOs 54,436 15,156 35,919 31,789 5,960 57,559 351,275
Hispanic
51 Gateway 5,051 4,803 11,646 4,401 99 2,801 43,028
52 United 2,839 444 2,018 450 17 4,963 16,548
53 Aetna 747 441 1,127 414 13 906 7,133
54 UPMC 1,732 523 1,689 507 9 984 8,294
57 AmeriHealth 10,375 1,400 17,063 6,756 17 3,038 66,368
Lehigh/Capital MCOs 20,744 7,611 33,543 12,528 155 12,692 141,371
TOTAL 75,372 22,801 69,623 44,458 6,128 70,419 493,850
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
24
Mandatory May 201 7 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 4 4 13 1 38 1
36 Gateway 0 1 0 0 0 8 0
37 AmeriHealth 0 2 0 4 0 5 0
56 Aetna 0 0 1 6 0 4 0
New West MCOs 0 7 5 23 1 55 1
Non-Hispanic
35 UPMC 836 4,020 10,530 11,955 3,509 30,223 526
36 Gateway 38 864 1,367 993 455 13,386 93
37 AmeriHealth 128 581 2,008 1,119 257 5,568 74
56 Aetna 38 638 1,736 1,233 270 9,105 49
New West MCOs 1,040 6,103 15,641 15,300 4,491 58,282 742
Hispanic
35 UPMC 19 30 76 136 33 1,915 1
36 Gateway 1 1 7 8 1 1,294 4
37 AmeriHealth 1 5 29 9 9 381 0
56 Aetna 1 8 23 15 5 742 0
New West MCOs 22 44 135 168 48 4,332 5
TOTAL 1,062 6,154 15,781 15,491 4,540 62,669 748
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
25
Mandatory May 201 7 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 1 42 4 6 10 130
36 Gateway 1 0 8 0 2 0 20
37 AmeriHealth 0 0 17 1 1 1 31
56 Aetna 2 0 4 0 1 3 21
New West MCOs 9 1 71 5 10 14 202
Non-Hispanic
35 UPMC 6,737 6,138 13,622 1,882 7,212 4,697 101,887
36 Gateway 975 285 3,816 30 894 654 23,850
37 AmeriHealth 356 1,231 2,170 1,400 1,091 764 16,747
56 Aetna 438 753 2,139 68 1,105 505 18,077
New West MCOs 8,506 8,407 21,747 3,380 10,302 6,620 160,561
Hispanic
35 UPMC 69 83 160 17 84 21 2,644
36 Gateway 7 4 33 1 12 14 1,387
37 AmeriHealth 0 8 32 8 14 3 499
56 Aetna 1 1 27 1 12 2 838
New West MCOs 77 96 252 27 122 40 5,368
TOTAL 8,592 8,504 22,070 3,412 10,434 6,674 166,131
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
26
Mandatory May 201 7 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 7 7 14 2 2 2 15 27
44 Geisinger 5 8 29 10 10 3 64 68
50 Aetna 6 4 21 2 2 2 18 23
New East MCOs 18 19 64 14 14 7 97 118
Non-Hispanic
41 AmeriHealth NE 2,808 6,483 2,491 1,133 1,426 695 5,758 11,447
44 Geisinger 4,584 2,554 6,269 5,051 6,890 1,574 25,237 34,551
50 Aetna 3,496 1,070 2,493 777 1,108 640 4,670 7,475
New East MCOs 10,888 10,107 11,253 6,961 9,424 2,909 35,665 53,473
Hispanic
41 AmeriHealth NE 44 524 70 16 79 62 1,223 5,483
44 Geisinger 55 170 125 70 234 135 4,652 8,861
50 Aetna 19 76 80 15 61 49 830 2,075
New East MCOs 118 770 275 101 374 246 6,705 16,419
TOTAL 11,024 10,896 11,592 7,076 9,812 3,162 42,467 70,010
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17 27
Mandatory May 201 7 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 10 1 24 0 3 12 6 2
44 Geisinger 15 0 30 1 9 25 7 7
50 Aetna 7 0 14 1 2 7 5 4
New East MCOs 32 1 68 2 14 44 18 13
Non-Hispanic
41 AmeriHealth NE 4,845 2,025 11,378 329 2,820 2,191 7,632 1,022
44 Geisinger 14,953 4,548 10,332 1,572 9,741 4,602 13,853 2,913
50 Aetna 1,483 1,559 3,678 311 3,347 1,031 2,976 924
New East MCOs 21,281 8,132 25,388 2,212 15,908 7,824 24,461 4,859
Hispanic
41 AmeriHealth NE 96 51 2,547 24 298 443 811 40
44 Geisinger 228 132 2,416 46 634 505 1,077 94
50 Aetna 31 74 974 3 199 202 203 20
New East MCOs 355 257 5,937 73 1,131 1,150 2,091 154
TOTAL 21,668 8,390 31,393 2,287 17,053 9,018 26,570 5,026
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
28
Mandatory May 201 7 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 1 5 1 143
44 Geisinger 1 8 0 8 12 6 326
50 Aetna 0 1 1 1 4 3 128
New East MCOs 1 9 3 10 21 10 597
Non-Hispanic
41 AmeriHealth NE 158 1,104 5,981 853 1,525 751 74,855
44 Geisinger 497 4,534 977 2,569 5,418 3,312 166,531
50 Aetna 151 924 588 714 1,038 644 41,097
New East MCOs 806 6,562 7,546 4,136 7,981 4,707 282,483
Hispanic
41 AmeriHealth NE 8 14 43 68 63 11 12,018
44 Geisinger 12 77 11 173 234 52 19,993
50 Aetna 3 18 7 36 54 8 5,037
New East MCOs 23 109 61 277 351 71 37,048
TOTAL 830 6,680 7,610 4,423 8,353 4,788 320,128
Racial/Ethnic information is self-reported by consumers.
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
29
Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP AND GENDER
SOUTHEAST
42 United 43 Aetna 45 Health
Partners 47 Keystone TOTAL
< 21 Yrs
Female 22,139 17,875 59,846 113,815 213,675
Male 22,959 19,042 60,846 121,611 224,458
Total 45,098 36,917 120,692 235,426 438,133
22-45 Yrs
Female 16,765 13,608 51,904 78,872 161,149
Male 13,814 12,896 29,661 45,062 101,433
Total 30,579 26,504 81,565 123,934 262,582
46-64 Yrs
Female 6,794 4,341 24,351 34,779 70,265
Male 7,214 5,469 19,799 28,961 61,443
Total 14,008 9,810 44,150 63,740 131,708
Over 64
Yrs
Female 372 284 965 1,551 3,172
Male 257 147 573 929 1,906
Total 629 431 1,538 2,480 5,078
TOTAL 90,314 73,662 247,945 425,580 837,501
SOUTHWEST
31 Gateway 32 United 34 UPMC 59 Aetna TOTAL
< 21 Yrs
Female 31,845 16,657 63,210 4,701 116,413
Male 34,067 17,829 66,865 4,835 123,596
Total 65,912 34,486 130,075 9,536 240,009
22-45 Yrs
Female 24,298 12,286 54,624 4,614 95,822
Male 13,673 8,957 34,234 4,457 61,321
Total 37,971 21,243 88,858 9,071 157,143
46-64 Yrs
Female 10,871 5,110 26,689 1,756 44,426
Male 8,196 4,684 21,392 2,056 36,328
Total 19,067 9,794 48,081 3,812 80,754
Over 64
Yrs
Female 153 77 434 31 695
Male 97 55 278 29 459
Total 250 132 712 60 1,154
TOTAL 123,200 65,655 267,726 22,479 479,060
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17 30
Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP AND GENDER
LEHIGH/CAPITAL
51 Gateway 52 United 53 Aetna 54 UPMC 57
AmeriHealth TOTAL
< 21 Yrs
Female 45,909 20,030 11,691 10,264 47,819 135,713
Male 48,318 20,972 12,162 11,129 50,286 142,867
Total 94,227 41,002 23,853 21,393 98,105 278,580
22-45
Yrs
Female 30,848 12,809 9,773 9,059 34,120 96,609
Male 14,959 7,818 7,027 6,153 16,769 52,726
Total 45,807 20,627 16,800 15,212 50,889 149,335
46-64
Yrs
Female 11,332 4,722 3,283 3,435 13,767 36,539
Male 8,111 3,885 3,142 2,965 9,239 27,342
Total 19,443 8,607 6,425 6,400 23,006 63,881
Over 64
Yrs
Female 427 166 125 96 522 1,336
Male 220 101 67 73 257 718
Total 647 267 192 169 779 2,054
TOTAL 160,124 70,503 47,270 43,174 172,779 493,850
NORTHWEST
35 UPMC 36 Gateway 37
AmeriHealth 56 Aetna TOTAL
< 21 Yrs
Female 26,554 6,388 3,906 4,805 41,653
Male 28,383 6,716 4,077 4,966 44,142
Total 54,937 13,104 7,983 9,771 85,795
22-45 Yrs
Female 20,750 5,005 3,563 3,646 32,964
Male 12,716 3,468 2,781 2,778 21,743
Total 33,466 8,473 6,344 6,424 54,707
46-64 Yrs
Female 9,287 1,991 1,468 1,465 14,211
Male 6,785 1,658 1,455 1,240 11,138
Total 16,072 3,649 2,923 2,705 25,349
Over 64
Yrs
Female 110 20 18 15 163
Male 76 11 9 21 117
Total 186 31 27 36 280
TOTAL 104,661 25,257 17,277 18,936 166,131
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
31
Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP AND GENDER
NORTHEAST
41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL
< 21 Yrs Female 22,084 47,769 11,547 81,400
Male 23,050 50,294 12,298 85,642
Total 45,134 98,063 23,845 167,042
22-45 Yrs Female 17,890 37,426 9,087 64,403
Male 10,658 21,658 6,677 38,993
Total 28,548 59,084 15,764 103,396
46-64 Yrs Female 7,378 16,732 3,560 27,670
Male 5,695 12,498 2,961 21,154
Total 13,073 29,230 6,521 48,824
Over 64 Yrs Female 172 297 84 553
Male 89 176 48 313
Total 261 473 132 866
TOTAL 87,016 186,850 46,262 320,128
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17 32
Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP
SOUTHEAST
42 United 43 Aetna 45 Health Partners 47 Keystone TOTAL
< 21 Yrs 45,098 36,917 120,692 235,426 438,133
22-45 Yrs 30,579 26,504 81,565 123,934 262,582
46-64 Yrs 14,008 9,810 44,150 63,740 131,708
Over 64 Yrs 629 431 1,538 2,480 5,078
TOTAL 90,314 73,662 247,945 425,580 837,501
SOUTHWEST
31 Gateway 32 United 34 UPMC 59 Aetna TOTAL
< 21 Yrs 65,912 34,486 130,075 9,536 240,009
22-45 Yrs 37,971 21,243 88,858 9,071 157,143
46-64 Yrs 19,067 9,794 48,081 3,812 80,754
Over 64 Yrs 250 132 712 60 1,154
TOTAL 123,200 65,655 267,726 22,479 479,060
LEHIGH/CAPITAL
51 Gateway 52 United 53 Aetna 54 UPMC 57 AmeriHealth TOTAL
< 21 Yrs 94,227 41,002 23,853 21,393 98,105 278,580
22-45 Yrs 45,807 20,627 16,800 15,212 50,889 149,335
46-64 Yrs 19,443 8,607 6,425 6,400 23,006 63,881
Over 64 Yrs 647 267 192 169 779 2,054
TOTAL 160,124 70,503 47,270 43,174 172,779 493,850
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
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Mandatory May 201 7 PLAN MAKE UP BY AGE GROUP
NORTHWEST
35 UPMC 36 Gateway 37 AmeriHealth 56 Aetna TOTAL
< 21 Yrs 54,937 13,104 7,983 9,771 85,795
22-45 Yrs 33,466 8,473 6,344 6,424 54,707
46-64 Yrs 16,072 3,649 2,923 2,705 25,349
Over 64 Yrs 186 31 27 36 280
TOTAL 104,661 25,257 17,277 18,936 166,131
NORTHEAST
41 AmeriHealth NE 44 Geisinger 50 Aetna TOTAL
< 21 Yrs 45,134 98,063 23,845 167,042
22-45 Yrs 28,548 59,084 15,764 103,396
46-64 Yrs 13,073 29,230 6,521 48,824
Over 64 Yrs 261 473 132 866
TOTAL 87,016 186,850 46,262 320,128
Source: PA Department of Human Services Enterprise Data Warehouse – Updated 6/23/17
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HealthChoices Enrollment 3rd Quarter 2016 AID CATEGORY DISTRIBUTION
Southeast B&CC <1%
Newly Eligible (19-20)
3%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 26%
SSI & HH 17%
TANF/HB/MAGI (Ages 0-20)
43%
Southwest B&CC <1%
Newly Eligible (19-20)
3%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 28%
SSI & HH 19%
TANF/HB/MAGI (Ages 0-20)
40% Lehigh/Capital B&CC
<1%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 25%
SSI & HH 15%
TANF/HB/MAGI (Ages 0-20)
46%
Newly Eligible (19-20)
2%
Northwest B&CC <1%
Newly Eligible (19-20)
3%
TANF/HB/MAGI (Ages 21+)
10%
Newly Eligible (21+) 26%
SSI & HH 19%
TANF/HB/MAGI (Ages 0-20)
42%
Northeast B&CC <1%
Newly Eligible(19-20)
3%
TANF/HB/MAGI (Ages 21+)
11%
Newly Eligible (21+) 27%
SSI & HH 16%
TANF/HB/MAGI (Ages 0-20)
44%
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.
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HealthChoices Enrollment May 201 7 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.
May 2017
Zone Percentage
Southeast 93.2%
Southwest 94.1%
Lehigh/Capital 94.2%
Northwest 94.3%
Northeast 93.9%
Total 93.8%
Source: Maximus
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Medical Assistance Transportation Program
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Based on Data Submitted by Each County
MATP 1Q FY 15/16
Southeast
COUNTY Total Expenditure Para Transit Trips Mass Transit Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Bucks $ 545,593 20,246 - 15,093 35,339 1.8%
Chester $ 634,251 15,712 1,728 2,927 20,367 1.8%
Delaware $ 1,225,350 28,753 - 14,616 43,369 1.2%
Montgomery $ 685,641 21,991 - 8,098 30,089 1.3%
Philadelphia $ 9,388,435 274,232 786,738 15,928 1,076,898 3.7%
HC-SE Zone $ 12,479,270 360,934 788,466 56,662 1,206,062 9.8%
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MATP 1Q FY 15/16
Southwest
COUNTY Total Expenditure Para Transit Trips Mass Transit Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Allegheny $ 2,327,010 48,022 143,153 32,916 224,091 4.3%
Armstrong $ 455,107 10,858 - 5,642 16,500 5.9%
Beaver $ 469,551 12,285 277 23,273 35,835 3.0%
Bedford $ 144,878 5,447 - 3,439 8,886 5.1%
Blair $ 291,416 14,053 1,941 3,358 19,352 2.8%
Butler $ 601,101 15,405 - 3,111 18,516 4.4%
Cambria $ 938,134 29,626 4,382 3,434 37,442 5.9%
Fayette $ 332,091 17,914 414 16,432 34,760 3.4%
Greene $ 146,280 5,015 - 2,566 7,581 4.2%
Indiana $ 296,504 8,613 492 6,220 15,325 4.4%
Lawrence $ 233,470 8,187 2,269 17,081 27,537 4.0%
Somerset $ 228,186 5,521 - 6,982 12,503 4.0%
Washington $ 521,912 19,286 856 14,179 34,321 4.5%
Westmoreland $ 563,123 18,882 99 18,330 37,311 2.6%
HC-SW Zone $ 7,548,763 219,114 153,883 156,963 529,960 58.3%
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MATP 1Q FY 15/16
Lehigh/Capital
COUNTY Total Expenditure Para Transit Trips Mass Transit Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Berks $ 528,002 22,366 13,066 3,632 39,064 2.6%
Cumberland $ 84,282 4,882 - 1,442 6,324 1.3%
Dauphin $ 754,055 29,515 6,669 1,971 38,155 2.6%
Franklin $ 128,901 3,904 - 2,798 6,702 1.7%
Fulton $ 104,685 2,352 - 1,276 3,628 8.1%
Huntingdon $ 150,245 3,601 - 5,488 9,089 5.9%
Lancaster $ 711,761 24,579 1,254 4,190 30,023 1.5%
Lebanon $ 326,461 17,373 138 1,394 18,905 2.0%
Lehigh $ 813,803 28,357 - 8,414 36,771 0.0%
Northampton $ 510,838 18,790 - 5,520 24,310 0.0%
Perry $ 94,201 2,226 - 1,215 3,441 4.1%
York/Adams $ 309,561 8,975 1,100 3,524 13,599 0.8%
HC-L/C Zone $ 4,516,795 166,920 22,227 40,864 230,011 30.7%
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MATP 1Q FY 15/16
Northwest
COUNTY Total
Expenditure
Para Transit
Trips
Mass Transit
Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Cameron $ 48,719 541 6 263 810 2.9%
Clarion $ 152,632 3,079 - 1,906 4,985 9.4%
Clearfield $ 262,209 8,115 - 7,162 15,277 4.1%
Crawford $ 277,579 3,458 750 13,821 18,029 5.1%
Elk $ 141,774 2,600 1 1,193 3,794 3.0%
Erie $ 703,388 26,627 - 5,220 31,847 1.3%
Forest $ 23,731 534 - 196 730 3.5%
Jefferson $ 240,549 4,938 - 3,311 8,249 7.2%
McKean $ 230,539 2,671 29 934 3,634 2.1%
Mercer $ 194,625 8,851 - 3,337 12,188 2.8%
Potter $ 146,543 1,846 - 1,256 3,102 6.8%
Venango $ 267,250 5,719 331 2,087 8,137 3.5%
Warren $ 120,714 3,365 117 2,754 6,236 4.4%
HC-Northwest Zone $ 2,810,252 72,344 1,234 43,440 117,018 56.1%
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MATP 1Q FY 15/16
Northeast
COUNTY Total
Expenditure
Para Transit
Trips
Mass Transit
Trips
Mileage
Reimbursement
Trips
Total Trips Client Utilization
Bradford/Tioga $ 275,791 6,516 179 1,818 8,513 0.0%
Carbon $ 249,065 6,707 - 1,368 8,075 2.8%
Centre $ 108,288 4,628 - 1,928 6,556 3.0%
Clinton $ 187,754 3,633 - 466 4,099 3.3%
Columbia $ 153,511 4,660 - 2,539 7,199 2.8%
Juniata $ 22,142 666 - 295 961 1.7%
Lackawanna $ 238,053 7,399 2,990 6,376 16,765 1.4%
Luzerne $ 388,064 20,240 1,090 7,789 29,119 2.5%
Lycoming $ 475,012 11,793 1,784 3,615 17,192 3.6%
Mifflin $ 118,238 5,131 - 847 5,978 3.7%
Monroe $ 191,419 5,528 825 4,444 10,797 1.3%
Montour $ 47,689 1,652 - 880 2,532 5.2%
Northumberland $ 130,239 7,293 - 2,970 10,263 2.7%
Pike $ 61,135 1,353 - 2,346 3,699 1.4%
Schuylkill $ 245,397 5,400 1,214 2,374 8,988 1.8%
Snyder $ 79,333 2,705 - 788 3,493 4.4%
Sullivan $ 19,082 343 37 96 476 3.5%
Susquehanna $ 128,918 2,547 - 1,612 4,159 4.0%
Union $ 46,373 1,639 - 564 2,203 5.5%
Wayne $ 116,258 4,209 - 1,371 5,580 2.9%
Wyoming $ 51,870 1,257 - 890 2,147 1.9%
HC-Northeast Zone $ 3,333,631 105,299 8,119 45,376 158,794 59.5%
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Useful Information
To view a complete Pennsylvania Medicaid Managed Care Organization (MCO) Directory go to http://www.dhs.pa.gov/provider/healthcaremedicalassistance/manag edcareinformation/ and choose the MCO Directory.
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