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Tuscarora Managed Care Alliance outlines Medicaid behavioral-health role, service counts for Franklin County
Summary
TMCA Executive Director Missy Weilman briefed commissioners on the county’s role in the Medicaid Behavioral Health Choices program, describing TMCA’s organization, service types, reinvestment rules and local service counts including 39,056 Medicaid enrollees in Franklin County and that about 45% of children are covered by Medicaid.
Missy Weilman, executive director of Tuscarora Managed Care Alliance, presented an overview of TMCA’s role as the counties’ contractor for Pennsylvania’s Medicaid Behavioral Health Choices program at the May 1 Franklin County commissioners meeting.
TMCA, Weilman said, is a component unit of Franklin County and acts as the local, capitated manager for behavioral health services. "We are a % at risk. We receive a monthly capitated payment, which is a set amount for each enrolled person to pay for all behavioral health services provided to that population," Weilman said, explaining the capitation model.
Weilman walked commissioners through program history, governance and services. She said Franklin and Fulton counties formed an intergovernmental agreement to create TMCA after the Commonwealth offered the right of first opportunity in 2006. TMCA holds a contract with the Pennsylvania Department of Human Services and subcontracts certain functions (for example, claims payment and provider network management) to PerformCare of Pennsylvania.
Weilman presented local service statistics from TMCA’s 2024 annual report: 39,056 Franklin County residents qualified for Medicaid (about one in four county residents), 45 percent of Franklin County children are covered by medical assistance, and 4,689 Franklin County individuals were served by TMCA-funded behavioral health services in the report period. She said 2,212 children were served and 802 of those children had autism; the program paid for roughly 25,000 therapy and psychiatry hours and about 11,000 drug- and alcohol-treatment hours in the community.
Weilman described reinvestment rules: up to 3 percent of savings from managed care may be reinvested in community services after stakeholder planning and Department of Human Services approval; examples included supportive housing, peer-support training and services addressing social determinants of health.
The presentation noted TMCA’s board includes three Franklin County commissioners and two Fulton County commissioners and that TMCA produces an annual report available on its website. Weilman also told commissioners that TMCA has experienced financial losses in only three of its 19 years of operation and that last year’s loss was tied to Medicaid redetermination activity that reduced the enrolled population. A large capitation revenue figure cited in the transcript appears inconsistent and is not reported here; the transcript did not provide a verifiable capitation-dollar figure.
Provenance: Weilman’s presentation and Q&A are recorded in the meeting transcript.
