Advancing the availability of health plan enrollment assistance in Pennsylvania

The Pennsylvania Department of Human Services (DHS) has selected us to continue administering the Pennsylvania Enrollment Assistance Program under a five-year, $62 million contract. In partnership with DHS, we have provided information about healthcare options, health plans, and providers to Pennsylvanians since 2009.

We currently assist eligible Pennsylvanians with health plan enrollments; under this latest contract award, the population will expand to include Children’s Health Insurance Program (CHIP) recipients. The state determines CHIP eligibility and plan assignment, while Maximus supports CHIP recipients for plan changes.

Digital solutions will be deployed to facilitate access to the information residents need through multichannel engagement. Building on the program’s website and mobile app, new technology enhancements will include 24/7 web chat, text messages, and email notifications. The program’s digital assets will also be updated to ensure digital accessibility compliance.

Additionally, we’ll apply a new AI-based training tool for staff supporting its digital customer contact center. Customer service agents will educate and guide residents through the enrollment process, assist them with selecting a health plan and primary care physician that meets their needs, and support them with plan changes. The training tool provides new agents with simulated call scenarios to enhance their preparation for providing residents with high-quality customer service.

In addition to managing the contact center, we’re also leading a statewide outreach effort to educate key stakeholders, including county leaders and community-based organizations, about the health coverage options available to consumers. The outreach team will facilitate consumer advisory meetings across Pennsylvania, to empower residents to engage and share their experiences and important feedback to help shape the future of the program.