County Assistance Offices (CAOs) have begun the process of recertifying and terminating some people from Medicaid beginning April 1.  For three years, many people no longer eligible for Medicaid were maintained on the coverage due to the pandemic and the federal declaration of a public health emergency.  The Medicaid continuous coverage provision of the public health emergency ended because of the federal Consolidated Appropriations Act signed into law in December 2022.

For the first time since 2020, a person’s MA coverage will end if they don’t complete their renewal when notified, or if they are ineligible at the time of their renewal.  The statewide renewal process will take place over 12 months.  No one will be disenrolled without having a chance to complete a renewal.

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 has been advising Pennsylvanians with MA coverage to make sure the state has their current address by going on Compass, the state’s MA online site.  They can also contact their County Assistance Office or call the Customer Service Center at 1-877-395-8930 (in Philadelphia, it’s 215-560-7226) to provide updated address information.

PA-ACP does not want patients to lose coverage simply because 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 has offered to assist the Shapiro Administration 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 have begun.
  • Encourage enrollees to update their contact information with the state by going on Compass or calling their County Assistance Office.
  • 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.
  • Medicare eligible patients who lose MA, but are not enrolled in Medicare have special enrollment periods of six-months to sign up for Part A and/or Part B, and three months to sign up for Part D without incurring a penalty for enrolling in Medicare late.  Individuals needing help enrolling in Medicare can contact the PA MEDI Program.  Individuals enrolled in Medicare and Medicaid who are no longer MA-eligible can also get help from PA MEDI to explore Medicare Advantage plans.
  • CHIP applications and renewals will also be processed by the CAOs starting April 17.