PENNSYLVANIA — Health care advocates are raising concerns surrounding the state’s upcoming plans to review Medicaid eligibility.
During the pandemic, federal rules allowed recipients to continue receiving coverage, regardless of being eligible or not. Come April 1st, Pennsylvania and other states will resume checking eligibility via renewal processes.
According to the PA Department of Human Services (DHS), “renewals will take place over 12 months, and no one will be disenrolled without having a chance to complete a renewal.”
But during a news conference on Tuesday, health care advocates raised concerns over whether the state is equipped to adequately review renewals for the 3.7 million people who are currently on Medicaid.
“We’re extremely concerned about whether there is sufficient staff and resources to handle this high volume of renewals,” said Amy Lowenstein, Director of Policy, Pennsylvania Health Law Project.
Download the FREE WPXI News app for breaking news alerts.
Lowenstein said that advocates are particularly worried that even eligible individuals could lose their coverage simply because of paperwork problems, processing errors or mail delays.
And, as those folks try to reapply, advocates worry the backlog will become even more unmanageable.
“The effects of this can be catastrophic on someone’s health. It can mean interruptions in cancer care for someone who’s undergoing chemo,” said Lowenstein. “It can leave an older adult with dementia, who relies on home care, alone without help.”
The advocacy groups said that DHS has been listening to their concerns and is working to mitigate issues.
But, according to Maripat Pileggi, Supervising Attorney with Community Legal Services, “there are still a few things that the state can do that it has not yet done to avoid that snowball effect from every happening in the first place.”
Pileggi said that they’d like to see DHS have a better plan in place for when a backlog is identified at a County Assistance Office. While a backlog is being managed, advocates believe that people should not have their benefits terminated in the interim.
Pileggi also said that they want people to have longer than 30 days to file an appeal, and that the state should likewise give itself more time to process appeals.
In the meantime, advocates advise not to panic, but to spend time now getting prepared.
Follow Channel 11 News on Facebook and Twitter. | Watch WPXI NOW
“Our message to Medicaid consumers is, be proactive,” said Antoinette Kraus, Executive Director, Pennsylvania Health Access Network. “Take steps now to figure out your renewal date. Update your information. If you do lose Medicaid coverage, appeal. Get your paperwork back during that reconsideration period and, if you’re not eligible, don’t go uninsured.”
The agencies advise updating your contact information with the County Assistance Office, which can be done via the COMPASS website.
Health insurance plans can be shopped on https://pennie.com/
For more help visit https://www.phlp.org/en/news/continuous-medicaid-coverage-related-to-the-pandemic-ends-april-1
A statement from DHS Spokesperson Brandon Cwalina reads as follows:
The Pennsylvania Department of Human Services (DHS) is confident in its ability to handle workloads as the Medicaid unwinding process gradually begins over the course of 12 months and stands ready to help Pennsylvanians stay covered. Staff are closely watching workload levels and will redistribute work as needed to make sure certain areas are not overburdened. New outreach mechanisms are in place to reach people through multiple channels to help mitigate potential mail delays.
DHS knew this change was coming and has been hard at work for more than 12 months planning for the eventual return to pre-pandemic Medicaid and CHIP eligibility determinations. This includes intensive preparation internally at DHS, with Pennie® -- Pennsylvania’s health insurance marketplace – as well as with stakeholders who may work with affected Pennsylvanians.
We want to be clear: no one will be kicked off of Medicaid on April 1. Everyone covered by Medicaid or CHIP will have the opportunity to complete a renewal or provide an update to their case information over the next year at the time of their usual renewal date.
DHS also said the following in their statement:
Because of recent changes to federal law, starting on April 1, everyone who gets their health coverage through the state must complete their annual renewal when it is their time to renew or they risk losing coverage; no one’s health coverage will automatically stop on April 1. All individuals who either do not return their renewal on time or who return their renewal but are found to be no longer eligible will have the opportunity to appeal. Fair hearings and appeals are overseen by DHS’ Bureau of Hearings and Appeals (BHA). In addition to BHA’s current fair hearing resources, BHA has onboarded additional staff to prepare for timely processing throughout the duration of the unwinding period.
The unwinding will not require a complete reintroduction of renewal processes, and staff have continued this work for the entire Medicaid population. While we were not disenrolling ineligible individuals throughout the continuous coverage period from March 2020-March 2023, DHS never stopped sending annual renewal paperwork during that time. DHS staff have continued to issue these forms and make case updates when they are completed by Medicaid recipients.
Pennsylvania will also utilize a full year (12 months) to complete renewals as recommended by the Centers for Medicare and Medicaid Services (CMS) and supported by the Consolidated Appropriations Act of 2023. The process of redistributing work is typical – our Office of Income Maintenance (OIM) has redistributed work to assist CAOs with heavier case workloads since 2014. DHS is working with our partners at the federal Centers for Medicare & Medicaid Services (CMS), the state General Assembly, and other parties to consider ways to improve services.
It is critically important that when a Medicaid or CHIP recipient receives their renewal, it is completed on time. Pennsylvanians can update their contact information, report changes in their personal circumstances, and check their renewal date:
- Online at www.dhs.pa.gov/COMPASS
- Via the free myCOMPASS PA Mobile App
- By calling 1-877-395-8930 (or 215-560-7226 if they live in Philadelphia)