October 28, 2026  – Pennsylvania is seeking public input on potential changes to its Medicaid managed care system, including stronger coordination between physical and behavioral health plans and new approaches to serving children with complex medical and developmental needs.

The Department of Human Services (DHS) issued a request for information on October 6 as it prepares for a future procurement of its Physical Health HealthChoices program. The program provides coverage through managed care organizations to approximately 2.3 million Medicaid beneficiaries across the state.

The request, identified as 26-RFI-20476, is an early planning step rather than a formal competition for contracts. Responses are due November 20, 2026.

Among the issues under consideration is how health plans can better share information across Pennsylvania’s separate physical and behavioral health managed care systems. Under the current structure, physical health services are delivered through statewide HealthChoices arrangements, while counties oversee behavioral health managed care contracts.

That separation can make coordination more difficult for people who need treatment for both physical and mental health conditions. Better information sharing could help plans and providers identify gaps in care, reduce duplicated services and improve follow-up after hospitalizations.

The state is also gathering input on whether children with intellectual or developmental disabilities could benefit from a specialized statewide managed care arrangement. No decision to establish such a plan has been announced. The question is part of a broader review of how Medicaid should serve children with complex health needs.

Other priorities in the Physical HealthChoices request include poorly controlled chronic conditions and perinatal and child health. DHS is asking stakeholders to consider network access, prior authorization, benefit design and the use of technology to support better outcomes.

Value-based payment is another area of interest. Pennsylvania is seeking ideas for financing and performance measures that would place greater emphasis on health outcomes rather than simply tracking whether plans complete required administrative activities.

For providers, the direction of the next procurement could affect contracting requirements, information systems and how performance is measured. For beneficiaries, the central question is whether changes lead to more reliable access to care, particularly when services cross organizational boundaries.

The state is separately seeking input on using Medicaid data to improve oversight and support evidence-based payment rate decisions. That request addresses transparency across managed care organizations, subcontractors, providers and other participants in the Medicaid delivery system. It is a distinct initiative from the Physical HealthChoices planning request.

Together, the efforts suggest Pennsylvania is taking a closer look at both the structure of its managed care contracts and the information it needs to monitor them. Stronger data systems may help the state identify spending patterns and access problems, but their value will depend on how findings are used.