HealthChoices Procurement Again Mired in Litigation
For the past six years Pennsylvania has been trying to rebid its HealthChoices Medicaid managed care contracts but every time it does, the losing bidders sue the state and the procurement process grinds to a halt.
Three times since 2015 the state has issued requests for proposals from managed care companies and all three times at least one of the losing parties has responded to its defeat by filing a lawsuit.
This is happening, many believe, because the state’s Medicaid managed care contracts are so lucrative – a stark contrast with state Medicaid payments to providers, which are generally considered poor.
The matter is now in the state’s Commonwealth Court, and the stakes are great: the contracts are for five years, with a possible option for another three.
The Philadelphia Inquirer has taken a look at the challenges that have prevented Pennsylvania from awarding new HealthChoices Medicaid managed care contracts in the article “Insurers want Pa.’s Medicaid business so badly they keep suing the state.”
Included in this month’s edition are articles about:
As a result, Pennsylvania has added nearly 400,000 people to its Medicaid rolls in the past year. Today, 3.2 million Pennsylvanians are enrolled in the state’s program, although among them are approximately 250,000 who would have been dropped from the program except for a federal requirement that the state not drop people from the program in exchange for a major increase in federal aid for the state’s program.
PACE Prescription Drug Program
PA General Assembly Update
Infection Control
While DHS’s area of endeavor is broad and goes beyond health care, Medicaid is an important aspect of its work and that importance is reflected in the plan, which includes descriptions of DHS’s ambitions in the following areas: