With passage of the federal omnibus appropriations bill last month, the Medicaid (MA) continuous coverage requirement will end April 1.  After that date, the program will return to normal eligibility processes, and all MA recipients must complete an annual renewal within 30 days of receipt to see if they are still eligible for coverage.  

For the first time since 2020, MA coverage will end if a person doesn’t complete their renewal, or if they are ineligible at the time of their renewal.  The statewide renewal process will take place over 12 months and no one will be disenrolled without having a chance to complete a renewal. But studies suggest that forcing to enroll people annually leads to loss of coverage due to simple administrative and procedural issues.

In Pennsylvania, 3.4 million people are covered by Medicaid, about one out of four people living in the Commonwealth.  That number is up from 2.2 million three years ago.  The Department of Human Services estimates that about 600,000 Pennsylvanians have kept MA benefits despite being ineligible under the federal PHE.

DHS is advising all people who now have MA coverage to make sure the state has their current address by going on Compass, the state’s MA online site. With the unwinding date known and new requirements in place, targeted communications and advocacy are more important than ever.

PA-ACP does not want patients to lose coverage if they aren’t aware they have to reapply for the program, or because of confusion with the process of applying for renewal - or different coverage.  A  family could lose coverage because it does not complete the renewal process, perhaps simply because the renewal letter got lost in the mail or because the family has trouble with the paperwork. With so many families experiencing many changes during this pandemic, we are likely to see a record number of procedural denials.

The Chapter urged the state to take a full year to complete these eligibility redeterminations.  And we’ve encouraged the Shapiro Administration to continue with current plans.  We’ve offered to assist by making our members and their MA patients aware of this process.

PA-ACP participated in two educational sessions for elected officials and staff to explain the state’s MA system, how it works, who it serves and the needs and participation by providers.  In 2022, we supported two bills to prevent DHS from limiting bidders for its MA and CHIP Health Choices contracts to hospital plans or health services plans providing coverage in every county in the state’s health regions.  DHS relented before the bills became law.

Some things PA-ACP members can do:

  • Spread the news to other members that eligibility redeterminations will begin April 1, 2023
  • Encourage enrollees to update their contact information with the state by going on Compass
  • Remind your MA patients to watch for, complete and return any reenrollment forms with updated info as soon as they receive them to avoid a loss of coverage.
  • Encourage families to check eligibility for other coverage, on Pennie® (Pennsylvania's official health and dental insurance marketplace) if they are no longer Medicaid eligible.