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Jefferson’s Medicaid insurance arm has won a bid to manage long-term care benefits statewide

AmeriHealth Caritas, affiliated with Independence Blue Cross, already has part of the business, and was selected for a new contract.

Thomas Jefferson University's Medicaid insurance business was selected to manage long-term benefits statewide for certain people eligible for both Medicare and Medicaid.
Thomas Jefferson University's Medicaid insurance business was selected to manage long-term benefits statewide for certain people eligible for both Medicare and Medicaid.Read moreThomas Jefferson University

Thomas Jefferson University’s Medicaid insurance arm this week won a chance to manage long-term care benefits for some of the 380,000 Pennsylvanians who participate in the $5 billion program called Community HealthChoices.

The program pays for nursing homes, home care, and other long-term services for low-income seniors and disabled people who qualify for both Medicare and Medicaid.

Jefferson’s Philadelphia-based Health Partners Plans Inc. was shut out of the business the first time contracts were awarded seven years ago. Aetna Better Health of Pennsylvania, part of a national company that has offices in Blue Bell, is another company that lost out previously, but was selected this time.

The Community HealthChoices win means that Jefferson’s Health Partners will operate statewide under two Medicaid programs. It already managed physical health benefits for 314,000 Pennsylvanians in June, though most of them are in Southeastern Pennsylvania.

“This opportunity allows us to expand access to medical care and long-term services and supports for the most vulnerable populations, ensuring that every individual has the opportunity to experience an overall better quality of life,” Denise Napier, CEO of Health Partners, said in an email.

The Pennsylvania Department of Human Services put the business up for bid in January. The winners were announced Thursday. Contracts, which typically run five years, must still be finalized, and the three losing bidders could file formal protests, causing delays.

Three companies that currently have Community HealthChoices contracts will continue. They are AmeriHealth Caritas, which is majority-owned by Independence Health Group; PA Health & Wellness, part of Centene Corp., the nation’s largest Medicaid-managed care company; and UPMC for You, owned by Pittsburgh health-care giant UPMC.

The new contracts are supposed to take effect Jan. 1.

State human services secretary Val Arkoosh described Community HealthChoices “as one of our farthest-reaching and highest-cost programs,” but also said it is “an investment in quality of life and  freedom of choice for older Pennsylvanians and adults with disabilities covered under the Medicaid system.”