Medicaid Unwinding Continues on the Ground and in Budget Discussions

The Medicaid continuous enrollment provision which expired March 31, had prevented all Medicaid disenrollments since March 2020.  On April 1, the Pennsylvania Department of Human Services started the redetermination and recertification process, and starting in May, MA recipients began to be disenrolled.  More than 97,000 Pennsylvanians have already been disenrolled since then, with 54,000 being found no longer eligible for benefits, and 43,000 for procedural reasons – such as failing to respond to requests.  Procedural disenrollments happen if the state cannot verify an individual's ongoing eligibility at renewal.

The Pennsylvania Department of Human Services  (DHS) has an Unwinding Progress Tracker with shared data on the number of Medicaid renewals being processed throughout the unwinding period. This data can be tracked by both county and zip code.

PA-ACP is urging its members to continue reminding MA patients and families to complete their Medicaid and CHIP renewals to prevent gaps in coverage.

Even with the disenrollments, Pennsylvania has 3,705,624 people remaining in MA/CHIP programs.  An additional 52,000 have qualified and been added in the last two months.  The state spends an average of more than $12,000 per capita for Pennsylvanians in the MA and CHIP programs, and DHS accounts for 43 percent of the state’s General Fund Budget (more than $19 billion.)  Members of the General Assembly have raised questions about the cost of false and fraudulent claims in the Medicaid program, and inserted those questions into the budget debate.

The House passed a state budget that’s more than $1.4 billion higher than the one proposed by Governor Shapiro, but Senate Republicans have not suggested they are willing to increase state spending.  With one week to go before the state’s June 30 budget deadline, lines have been drawn, and no decisions have yet been made.  It’s possible that we’ll be in July before a budget is finally passed.  At the same time, missing that deadline won’t mean a halt to payments and provision of health care benefits to Medicaid recipients.

PA DHS also published a Continuous Eligibility Unwinding Plan, which outlines its strategy for maintaining continuity of care for all individuals who are eligible for health care benefits through Medicaid or CHIP. You can review the plan here for more information on Pennsylvania's plan to keep kids covered throughout the Medicaid and CHIP unwinding.

According to the Kaiser Family Foundation, available data from all states shows the average percentage of disenrollments due to procedural reasons is 76%, which suggests Pennsylvania’s efforts through the Department and partners locally and like PA-ACP are helping ease the process.  You can also find the Kaiser Family Foundation data on Medicaid and CHIP Enrollment by state here.

The US Department of Health and Human Services Secretary Becerra recently sent a letter to all Governors encouraging states to take up all policy options and flexibilities they can to protect eligible individuals and families from procedural disenrollment. The letter from Secretary Becerra is online.