The managed care contracts, covering physical health under the state’s HealthChoices Medicaid program, are valued at $12 billion over the course of three years, according to the report. The largest winners of the bids include Pittsburgh-based Gateway Health Plan and Pittsburgh-based UPMC for You, with Gateway covering all of the state’s five zones and UPMC covering four.
The Pennsylvania Department of Human Services first announced the contracts in April 2016. However, the contracts had to undergo a second procurement process because Aetna blocked the contracts’ implementation with a preliminary injunction.
Aetna won a contract to cover one of the state’s five zones last year but will not cover any zones after the most recent bid. UnitedHealthcare was in all five zones in April but is now excluded from all zones.
UnitedHealthcare, Aetna and Philadelphia-based AmeriHealth Caritas are protesting the bids. AmeriHealth’s participation in five state regions was narrowed to three, according to the report.
“We strongly disagree with the state’s decision, have filed a formal protest with the Pennsylvania Department of Health Services, and are aggressively pursuing all options and remedies at our disposal,” a UnitedHealthcare spokesperson said in a statement to The Inquirer.
The new contracts are slated to start in June.
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