Erie, Crawford Medicaid recipients must choose HMO by Thursday [Erie Times-News, Pa.]

Sept. 06--A plan to switch 125,000 northwestern Pennsylvania Medicaid recipients into one of four managed-care plans has sent some patients and medical providers scrambling.

People enrolled in either Access Plus or United HealthCare Community Plan have until today to choose a new plan. They must pick from among AmeriHealth Mercy Health Plan, CoventryCares, Gateway and UPMC for You.

"I have a tremendous number of patients on these plans, and they haven't been informed about the switch," said David Shapter, an Erie pediatric dentist. "I haven't been informed."

The Pennsylvania Department of Public Welfare is forcing Medicaid recipients to enter a managed-care plan as a way to reduce costs, said Donna Morgan, DPW spokeswoman.

The HealthChoices program, which began in 1997, has already been rolled out in 32 Pennsylvania counties and takes effect in 13 northwestern Pennsylvania counties -- including Erie and Crawford counties -- on Oct. 1.

"We sent information packets to all recipients in (northwestern Pennsylvania) in August, followed by a letter and a phone call if they didn't sign up for an HMO," Morgan said.

"DPW staff members have also been traveling around the state, informing providers about the switch."

The Pennsylvania Health Law Project held an informational meeting about the changes Aug. 13 in Erie.

Shapter said he wasn't notified of the meeting by the DPW or any of the four participating HMOs, but by word of mouth.

"It's not just my office," Shapter said. "Other dentists, doctors, nursing home officials, we aren't getting the information we need about these changes."

Now Shapter must quickly decide which HMOs he will accept for payment. The changes are scheduled to take effect Oct. 1, but he is already seeing patients who are covered by one of the four managed-care plans.

Some providers aren't selecting all four HMOs. UPMC Hamot isn't accepting AmeriHealth Mercy, and Corry Memorial Hospital is only accepting Gateway, according to a list provided by the DPW.

"I can't possibly participate in all four plans," Shapter said. "It would mean an extra 4,000 to 10,000 patients because I get referrals for Medicaid patients from all over the area."

Shapter and other medical providers can still get reimbursed for treating patients with insurance plans they don't accept, but the process is more difficult and not guaranteed, Shapter said.

The DPW is advising Medicaid recipients to pick a plan that includes their primary-care physician and any specialists they see. They can find that information by calling 1-800-440-3989 weekdays between 8 a.m. and 6 p.m.

DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.

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