On April 1, 2023, Pennsylvania will be able to terminate people from Medicaid for the first time since the COVID-19 pandemic began three years earlier. This is because the federal Consolidated Appropriations Act of 2023, signed into law last month, ends a pandemic-era requirement that states keep most people enrolled in Medicaid regardless of eligibility.
Medicaid recipients who are no longer eligible will not lose their Medicaid all at once. Instead, Pennsylvania will take 12 months to review eligibility for the entire Pennsylvania Medicaid population, currently numbering more than 3.6 million. This 12-month period is called the “unwinding” period. Most people will have their eligibility reviewed when their Medicaid renewal normally would be due.
If a person is determined ineligible for Medicaid, they will be sent a denial notice. They will be able to appeal this decision by following the directions on the notice. If they appeal timely, they will not lose their coverage during this process. In addition to appealing, people may request that DHS reconsider a Medicaid termination within 90 days without having to submit a new application. Click here for the DHS FAQ about the end of continuous coverage.
If you are enrolled in Medicaid, it is important to update your contact information with the County Assistance Office (CAO) so that you can receive their correspondence. You can do so on the COMPASS website, on the myCOMPASS PA mobile app, or by calling the Statewide Customer Service Center at 1-877-395-8930 (in Philadelphia, call 215-560-7226.) You will also have the option to sign up for text alerts.
Those who are no longer eligible for Medicaid may be able to enroll in other affordable health insurance. Pennie, Pennsylvania’s state-based health insurance marketplace, will have a 120-day special enrollment period for those losing Medicaid during the "unwinding” to enroll in a qualified health plan, including plans with significantly subsidized costs. Those who enroll in Pennie within 60 days of losing Medicaid can request retroactive coverage to the date they lost Medicaid. Similarly, people who lose Medicaid and were eligible for but not enrolled in Medicare have special enrollment periods of six-months to sign up for Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) and three-months to sign up for Medicare Part D (prescription insurance) without incurring a penalty for enrolling in Medicare late. These Medicare special enrollment periods for loss of Medicaid are not limited to the “unwinding” period.