COVID-19 Resource Center

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Last Update: October 19, 2020

As the COVID-19 public health emergency continues, the Pennsylvania Health Law Project (PHLP) is committed to making sure those with Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) coverage have services, and to securing insurance coverage for the uninsured. 

PHLP staff are working remotely through the crisis and are available to counsel and represent Pennsylvanians throughout the state.  Our toll-free Helpline (1-800-274-3258) remains open every Monday, Wednesday, and Friday from 8 AM to 8 PM.  We can also be reached at

Our Advocacy

August 2020
PHLP hired two additional outreach and community navigators to ensure that low-income and marginalized Pennsylvanians have equitable access to COVID-19 testing and treatment.  

Over the past two months, our navigators have identified marginalized communities struggling to get tested and treated for COVID-19, investigated the availability of testing and treatment, targeted outreach efforts to these communities to increase awareness of testing and treatment options, and helped individuals in these communities connect to COVID-19 related services.  

Right now, our navigators are researching and creating resources related to testing in the Pittsburgh, Philadelphia, Harrisburg/York, and Lehigh Valley areas. For more details, visit our COVID-19 Testing Sites page.

April 24, 2020
We joined the Center for Advocacy for the Rights and Interests of the Elderly (CARIE) and a handful of other stakeholders in sending a letter to Governor Wolf urging stronger action during the COVID-19 pandemic to protect residents and staff of nursing homes, assisted living facilities, and personal care homes. 

April 21, 2020 
We signed onto Disability Rights Pennsylvania (DRP)'s letter to the Wolf Administration requeting increased transparency related to congregate care locations with COVID-19 outbreaks, including requesting that the Administration publicly release a list of the names and locations of nursing homes, assisted living facilities, and personal care homes with COVID-19 positive residents and/or staff as well as the number of deaths at each facility.

March 17, 2020
Prior to the state's submission of the 1135 Waiver and Appendix K requests, we organized organizations across the state to sign a detailed letter to state officials outlining COVID-19 policy recommendations aimed at protecting Pennsylvanians during the crisis.

Federal & State Updates

Gov. Wolf Signs Second Extension of Disaster Declaration Beyond September 1

On August 31, 2020, Governor Tom Wolf signed a second renewal of his 90-day disaster declaration for the COVID-19 pandemic.  The disaster declaration was originally signed on March 6, following the announcement of the first two presumptive positive cases of COVID-19 in our state.  On June 3, Governor Wolf announced he would extend the original declaration another 90 days. 

MA Beneficiaries Turning 21 During the COVID-19 Emergency Continue to Qualify for EPSDT Services

Medical Assistance (MA) beneficiaries turning 21 on or after March 18, 2020 continue to be eligible for the same MA services provided to individuals on MA under 21 years of age until the end of the month in which the national public health emergency ends. This means beneficiaries who turn 21 and otherwise age out of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) MA benefit, continue to be eligible for the same scope of services they received before turning 21. This includes services that are not covered for adults over age 21 otherwise, such as private duty shift nursing and Intensive Behavioral Health Services (IBHS).

Renewal of Federal PHE Allows State to Continue Pediatric Shift Nursing “Freeze”

The Department of Human Services (DHS), with the extension of the federal Public Health Emergency, will continue the protections currently in place for pediatric skilled nursing services.  The federal Public Health Emergency was most recently renewed effective October 23, 2020 and for 90 days thereafter (i.e. through the end of January 2021.) 

As part of its response to the COVID-19 emergency, DHS in early April removed prior authorization requirements for certain services and effectively “froze” existing authorizations for in-home pediatric skilled nursing services.  According to this guidance, shift nursing authorizations in place as of early April are continued at the same level of hours until further notice from DHS.  New requests for services and requests for additional hours are not covered by this guidance and still require prior authorization.  Any shift nursing requests newly approved since April are covered by these protections.

In taking this action to suspend prior authorization requirements, DHS is exercising authority temporarily available through federal approval of its 1135 Waiver requests.  The ability to waive or modify normal requirements under this section of the Medicaid Act is conditioned on a federal Public Health Emergency being in effect.  

Families or advocates with questions regarding these shift nursing protections should contact our Helpline at (800) 274-3258.

No Prior Authorization needed for certain services

The Department of Human Services (DHS) has temporarily removed prior authorization requirements for certain services.  The following services will not require prior authorization (permission from the insurer) for the duration of the COVID-19 emergency:

  • Hospice services (prior authorizaiton is required after 30 days for individuals in Physical Health MCOs or Community HealthChoices MCOs);
  • Emergency or urgent inpatient hospital admissions;
  • Long-term care acute hospitalization, for the first 30 days of care;
  • Certain Durable Medical Equipment (DME) and supplies including feeding supplies, respiratory supplies, urinary catheters, and ostomy supplies (see above link for full list of items not requiring prior authorization);
  • CT scans of the chest related to the diagnosis or treatment of COVID-19;
  • Sublocade injections
  • Inpatient rehabilitation, for the first 30 days of care;
  • Nursing home services, for the first 30 days of care;
  • Home health aide services, for the first 28 days of service; and
  • Skilled nursing (i.e. shift nursing) if the request is to continue the currently-authorized number of hours

The Department has also expanded the types of providers that may order home health services during the pandemic. Specifically, licensed practitioners practicing within their scope of practice, including but not limited to nurse practitioners and physician assistants, may order home heath services during the crisis.

No change in MA or CHIP eligibility criteria

In accordance with guidance issued by the Centers for Medicare & Medicaid Services (CMS),  Pennsylvania will maintain Medicaid and CHIP eligibility standards, not charge premiums that exceed those that were in place as of January 2020, and cover any cost sharing, testing, services and treatments related to COVID-19. 

No Termination of coverage during the crisis

Pennsylvania will provide continuous MA, CHIP, LTC (nursing home) and Waiver coverage for the duration of the public health emergency. Most people who had MA, CHIP, LTC, or Waiver coverage on or after March 18, 2020 cannot lose that coverage until the end of the emergency. Details on the few exceptions to continuous coverage are detailed in this Operations Memorandum.

Unfortunately, PHLP has already heard from consumers whose coverage was wrongfully terminated during the crisis; the state has committed to reopening these individuals' benefits as soon as possible, in accordance with this Policy Clarification released on April 24, 2020.

If you had MA, CHIP, LTC, or Waiver coverage on March 18 and your coverage is terminated while the COVID-19 crisis is still going on, call PHLP's Helpline at 1-800-274-3258!

Feds Approve PA’s Request For Medicaid Flexibility  

1135 Waiver
During a disaster or emergency such as COVID-19, the federal government may temporarily waive or modify certain Medicare, Medicaid, and CHIP requirements to ensure that sufficient health care services are available to meet the needs of consumers.  

Knowing that Pennsylvania Medicaid officials were preparing their waiver application, on March 17, PHLP and dozens of other advocates and providers urged the state to ask for permission to halt all terminations of Medicaid coverage and to direct MCOs insurers to halt all service denials.  The entirely of our recommendations can be found here.   

On March 27, the federal government approved Pennsylvania's request for Medicaid flexibility during the Coronavirus emergency. Click here to view CMS’s approval notice.  The federal government’s “approval” of the waiver does not change all things.  The state must still take action to use the authority granted by the waiver, which applies to the Medicaid Fee-for-Service Program, HealthChoices managed care for physical and behavioral health services, Community HealthChoices (CHC), and Home and Community Based Services (HCBS) waivers. 

Appendix K

Through a different pathway, known as Appendix K, the federal government also approved changes to waivers operated by the Office of Long-Term Living (OLTL) and the Office of Developmental Programs (ODP). The changes are effective for the Adult Autism Waiver and the Community HealthChoices (CHC) waiver from March 6, 2020 through June 30, 2020; and from March 11, 2020 through March 11, 2021 for the OBRA, Consolidated, P/FDS, and Community Living Waivers. Click here to see a list of the Appendix K approvals.

Under the CHC Waiver Appendix K, initial Level of Care Assessments using the Functional Eligibility Determination (FED) tool, as well as Annual Reassessments and Comprehensive Needs Reassessments, may be conducted using phone or video conferencing. The face-to-face requirement is temporarily waived for these assessments in Counties in the Yellow and Red Phases of Reopening. When counties are in the Green Phase of Reopening, participants must be offered an in-person assessment or reassessment and told that waiver services might be reduced or changed. Knowing that the assessment may impact services may influence whether someone wants an in-person or telephone assessment.

Additionally, for the duration of the COVID-19 emergency, OLTL has temporarily allowed certain spouses, legal guardians, and persons with power of attorney to serve as paid direct care workers (e.g. PAS workers) when scheduled workers are not available due to COVID-19 and when the participant’s emergency backup plan cannot be implemented. This exception will be reviewed on a case-by-case basis by OLTL.

Appeal deadlines extended

The County Assistance Office must give individuals an extra 60 days to appeal MA and Waiver denials or terminations. This means individuals who lose MA or Waiver during the crisis will have 90 days to appeal the decision, rather than the typical 30 day deadline. But remember: anyone who had MA or Waiver on or after March 18 cannot lose that coverage for the duration of the crisis! 

Grievances & Fair Hearings during COVID-19 Crisis

Previously, CHC-MCOs could not reduce PAS and other Waiver services. However, that moratorium has been lifted.  CHC-MCOs can now reduce both waiver and non-waiver services. Physical and Behavioral Health MCOs can also reduce or terminate services during the crisis. Normal Grievance and Fair Hearing rights apply to any reduction or termination of services. 

The state has directed BH-MCOs to offer telephonic or videoconference Grievance reviews, if a member’s request for an in-person review cannot be accommodated.  PHLP expects the state to issue similar guidance to PH-MCOs and CHC-MCOs.    

Fair Hearings
For the duration of the COVID-19 crisis, DHS Fair Hearings involving MA eligibility matters and service denials will be held exclusively by telephone beginning April 1. The Bureau of Hearings and Appeals (BHA) cancelled all fair hearings scheduled from March 17-31, 2020. Those hearings are being rescheduled to telephone hearings.  

PHLP is advocating for interim benefits for those without continued benefits or services in place while this emergency progresses.  This would mean that if Fair Hearings are delayed a person would be able to temporarily receive their benefits or services while awaiting the hearing.  This is already a requirement when a Fair Hearing decision has not been issued within 90 days of a person first appealing a Medicaid benefits or service denial, but it is not a well-known right.  

No Rationing Medical Care Based On Disability; Age 

On March 28th, the U.S. Department of Health and Human Services’ civil rights office told medical providers that they may not deny medical care to people based on their disabilities or age during the coronavirus emergency.  The directive, released in a bulletin, came days after disability rights advocates filed complaints arguing that protocols to ration lifesaving medical care — adopted by Alabama and Washington State — were discriminatory. 

On March 27th, the Pennsylvania Medical Assistance Advisory Committee (MAAC) unanimously approved a resolution exhorting Governor Wolf to ensure that when it comes to the allocation of life-saving treatment 1) patients are not discriminated against because of their Medical Assistance Insurance status, and 2) people with disabilities are not given lower priority because of preexisting disabilities, even when those conditions require more scarce resources.  The MAAC also requested that any guidelines developed be developed with the stakeholders and experts listed in the resolution, and that they be released to the public once finalized.  

Governor Wolf has also stated his strong commitment to ensuring all Pennsylvanians receive fair and equitable access to lifesaving health care during the COVID-19 pandemic; and will not tolerate discrimination in the allocation of lifesaving resources based on any factor including, but not limited to age, disability and socioeconomic status. 

Disability Rights Pennsylvania (DRP) has opened a Health Care Rationing Hotline during the pandemic. Individuals with disabilities who experience discrimination in health care rationing, who are denied effective communication at the hospital, or who are prohibited from bringing a needed family member or staff with them into the hospital should contact DRP's Hotline at 1-800-692-7443 ext. 402.

EVV Delayed Until October  

Due to the COVID-19 crisis, Pennsylvania announced it is delaying the implementation date for Electronic Visit Verification (EVV) for direct care workers providing Personal Assistance Services (PAS). The new implementation date is October 1, 2020. For more information, visit the DHS EVV website.

Medicare Part B Applications During COVID-19

In addition to mail, Medicare beneficiaries can now enroll into Medicare Part B coverage by fax, and in some cases, online. 

CMS added a new online enrollment option for people age 65 or older and who have or had group health plan (GHP) coverage within the last 8 months through their or their spouse’s current employer. To apply online, you will need your Medicare number, your current address and phone number, a valid e-mail address, and documentation verifying your Group Health Plan (GHP) coverage through your or your spouse’s current employment. 

To apply by fax, send the Medicare Part B form, CMS-40B and CMS L564—Request for Employment Information, along with proof of employment, GHP coverage, or Large Group Health Plan (LGHP) to the Social Security Administration at 1-833-914-2016. This information is reflected on SSA’s How to Apply for Just Medicare page.  As a reminder, the applications for Part A and the Low-Income Subsidy (Extra Help) can be completed online. Source: Justice in Aging.

State Policy Documents

Other COVID-19 Resources

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