PinnacleHealth, UPMC can’t agree on contract terms for patients with lower incomes

July 19--Hundreds of adults and children with lower incomes will lose access to PinnacleHealth System services as of Oct. 1.

PinnacleHealth and UPMC Health Plan have been unable to agree on contract terms for coverage for people covered by medical assistance and children covered by CHIP.

A PinnacleHealth spokeswoman said about 500 PinnacleHealth patients are affected. A UPMC Health Plan spokesman said the affected plans cover about 4,000 people in the Harrisburg region, although most don't use PinnacleHealth services.

"For the past several months, PinnacleHealth has been negotiating with UPMC to renew the contract for their Medicaid and CHIP programs. Unfortunately, we have been unable to reach a mutually satisfactory agreement, and it appears at this time we will not be able to resolve our differences," PinnacleHealth spokeswoman Kelly McCall wrote in an email.

PinnacleHealth is contacting the patients and encouraging them to enroll in other Medicaid managed care plans it has contracts with: Aetna Better Health, AmeriHealth, Gateway Health or United Healthcare Community Plan.

UPMC Health Plan spokesman Bill Modoono said in an email, "We would be open to discussions with Pinnacle leadership and we are committed to ensure that our members continue to receive the quality care they expect from UPMC for You and UPMC for Kids."

He also said UPMC expects affected members will be able to find non-PinnacleHealth providers, and it will inform them of the situation.

Pennsylvania contracts with private insurers to manage the benefits of people covered by Medicaid, which is the state-federal health insurance program for the poor, and CHIP, a government-subsidized program for children from families with lower incomes.

Acccording to Modoono, UPMC for You has been the top-rated medical assistance plan in Pennsylvania in nine of the past ten years.

UPMC Health Plan is owned by the University of Pittsburgh Medical Center.

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