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Medicaid market share: Who pays for long-term care, nursing home services in Philly area

Philadelphia Inquirer - 3/13/2019

March 13-- Mar. 13--Independence Health Group's Keystone First unit enrolled 52.2 percent of the 132,638 Southeastern Pennsylvania residents in the state's new Medicaid managed care program for community-based supports and long-term care, such as nursing homes, new data from the Pennsylvania Department of Human Services show.

The program, started in January in the Philadelphia region, requires elderly Medicaid beneficiaries and younger individuals with disabilities to select a managed-care provider to continue receiving home care and other services paid for by Medicaid.

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It replaces fee-for-service Medicaid and is expected the make the billions spent on such services more effective. Statewide the program was valued at $5.4 billion when it was announced in 2016.

Two other providers, Centene Corp.'sPennsylvania Health & Wellness and UPMC Community Health Choices, also competed for the business. Centene's share in January was 24.2 percent; UPMC's was 23.6 percent.

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