The Pennsylvania Health Law Project (PHLP) is monitoring the impact of the novel coronavirus (COVID-19). As COVID-19 spreads, we are committed to making sure those with Medical Assistance (MA) and the Children’s Health Insurance Program (CHIP) coverage have services, and to securing insurance coverage for the uninsured. PHLP staff 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 firstname.lastname@example.org.
The Pennsylvania Department of Health’s website has the most accurate information on the spread of COVID-19, including statewide mitigation and stay at home orders. At the time of publication (March 31, 2020) there were 63 deaths linked to 4,843 confirmed COVID-19 cases.
Will MA & CHIP Pay For COVID-19 Tests?
Yes. Medical Assistance (MA) and the Children’s Health Insurance Program (CHIP) will cover testing for COVID-19 when your doctor or health care professional determines it necessary. There is no co-pay for testing which means consumers pay nothing out-of-pocket. No prior authorization (permission) from your insurer is required to get tested.
The Pennsylvania Department of Health has released a fact sheet with information about how to get tested for COVID-19. Testing had been prioritized for people who are severely sick, people in facilities, people in contact with known cases of COVID-19, and health care providers; however, testing kits are becoming more widespread and available. If you are having symptoms and want to get tested, call your doctor, health insurance company, local health department, or the PA Department of Health at 1-877-PA-HEALTH (1-877-724-2584).
Note About Testing with Medicare Coverage: Medicare also covers COVID-19-related laboratory testing when ordered by a physician without any coinsurance or deductible. The standard Part B deductible ($198 in 2020) applies to other COVID-19-related outpatient Medicare services, besides laboratory tests. CMS released a fact sheet addressing Medicare Coverage and Payment Related to COVID-19.
What Services Will MA Cover to Treat COVID-19?
There is no specific antiviral treatment for COVID-19, but Medical Assistance (MA) covers a broad range of services that relieve symptoms:
- Imaging (e.g., CT Scans, X-Rays) & Diagnostic Testing
Hospital Care (Inpatient & Outpatient)
Emergency Ambulance Transportation
Non-Emergency Transportation to MA Covered Appointments
Home Health Services
Nursing Facility Care
Immunizations: There is currently no vaccine for COVID-19. The influenza vaccine does not protect against coronavirus infection; however, an annual flu vaccine can help keep you healthy during the flu season.
Prescription Drugs: MA coverage includes over-the-counter medications for fever relief and other medications related to the treatment of virus symptoms when prescribed by your doctor or health care practitioner. To ensure you have a 30-day supply of prescription drugs, refills may be covered before the refill date.
Not all the covered services described above must be prior authorized (approved by your insurer). For those services that do require prior authorization, the state has directed MA managed care organizations (MCOs) to expedite reviews for services related to COVID-19. Services may be approved for longer periods of time when necessary to ensure uninterrupted services. See below for more in-depth discussion about service delivery.
HOW COVID-19 IMPACTS ELIGIBILITY & RENEWAL OF MA COVERAGE
Medical Assistance (MA) coverage should not end during the emergency period; this is a condition for the state’s receipt of enhanced federal match funds passed as part of the Families First Corona Virus Response Act. Again, Pennsylvanians who have MA coverage on or after March 18th cannot lose that coverage until the end of the public health emergency, except in cases where the person voluntarily withdraws, is no longer a state resident, or is deceased.
Are County Assistance Offices (CAOs) Open During the Emergency?
All County Assistance Offices (CAOs) across the state are closed to the public effective March 17th but are still processing MA applications and requests for other public benefits. The state had reported that CAOs might reopen to the public as soon as Wednesday, April 1st but that seems unlikely given new orders for social distancing through at least April 30. PHLP will continue to monitor CAO closure information and give updates as we have them.
Even though CAOs are closed to the public, you can still apply and renew MA and CHIP coverage by phone (1-866-550-4355 or on the COMPASS website at www.COMPASS.state.pa.us. Applicants can download the MyCompassPA app to their Apple and Android devices.
Applicants can also complete a paper application (available here) and either mail the application to the CAO, or dropping it off at the CAO’s secure drop box. Note that there is no way to obtain a receipt for dropping off application paperwork; be sure to keep all originals and only drop off in person if you have no other way of submitting paperwork.
Changes impacting benefits (e.g., new address, change in household size) can still be reported through the Statewide Customer Service Center at 1-877-395-8930
Uninsured applicants who have COVID-19 and seek MA coverage can get a faster decision on their MA application by noting in the comment section of their COMPASS application or their paper applications that their medical condition affects their ability to work.
The state has instructed caseworkers to accept self-attestation for all MA eligibility criteria (e.g., income), excluding verification of citizenship and immigration status, when documentation is not available. Finally, anyone seeking to renewal Medical Assistance coverage should not lose that coverage because of missing information or documentation (e.g., payroll stubs).
How Does COVID-19 Impact Immigrants and Emergency Medical Assistance (EMA)?
In Pennsylvania, no one should be denied Medical Assistance for COVID-19 testing, diagnosis or treatment because of their immigration status. COVID-19 is an Emergency Medical Condition, therefore Emergency Medical Assistance (EMA) will include coverage of COVID-19 testing, diagnosis, and treatment.
Moreover, using MA for COVID-19 testing, diagnosis and treatment creates no public charge risk. As has always been the case under the new public charge rule, the very large majority of people who are eligible for MA can receive and use benefits without any public charge risk. In addition, US Citizen and Immigration Services recently announced that COVID-19 testing, diagnosis and treatment (including a vaccine if/when one becomes available) will not be considered during public charge tests, even if Medical Assistance is used to access these services.
Will Medical Assistance for Workers with Disabilities (MAWD) End If I Am Furloughed?
No. Even though MAWD ordinarily requires individuals to work to receive benefits, people with MAWD coverage should ask to be granted a Good Cause exception to keep their benefits when they are furloughed from employment. In these circumstances, MAWD coverage will not be canceled based on a lack of employment. Good Cause can also be granted to waive MAWD premium payments for up to two months (which might be extended with the passage of the Families First Corona Virus Response Act).
What if I Need to Apply for Long-Term Care?
The state continues to process applications for MA funded long-term care for older adults and individuals with disabilities served through providers licensed by the Office of Long-Term Living, including personal care homes and in-home care. The Independent Enrolment Broker (IEB) is still processing applications. To apply for waiver services, call the PA Independent Enrollment Broker (PA IEB) at 1-877-550-4227. It has been reported to PHLP that functional eligibility determinations (FED) which assess whether applicants meet the clinical standards to qualify for in-home services, may be conducted remotely using phone or video conferencing; the face-to-face requirement has been temporarily waived.
The Office of Long Term Living (OLTL) is suspending long-term care clinical eligibility redeterminations during the COVID-19 emergency. The Office of Developmental Programs (ODP) has extended eligibility redeterminations to 18 months, so participants in ODP’s programs will also not lose services during this period.
Do the Direct Payments to Households Through the CARES Act (Stimulus) Impact Eligibility for Medical Assistance?
No. The payments do not count as income for Medical Assistance and the Children’s Health Insurance Program (CHIP). As a reminder, the CARES Act includes “recovery rebates” of $1,200 per adult ($2,400 for a married couple) and $500 per dependent child age 16 or younger. A married couple with two children is therefore eligible for $3,400. The rebates phase down gradually for couples with incomes above $150,000 and individuals with incomes above $75,000. It has been reported to PHLP that if the rebate funds are not spent within 9 months, they can be counted along with other resources (i.e., money in bank, checking account balance, cash on hand) which could adversely impact eligibility for MA-funded long-term care.
HOW COVID-19 IMPACTS TREATMENT, SUPPORTS & SERVICES
As noted above, all Medical Assistance (MA) funded services and support delivered by Medicaid Managed Care Organizations (MCOs) and the Fee-for-Service program remain active. MCO and ACCESS cards can still be used to obtain care, just like always. Contact PHLP’s Helpline at 1-800-274-3258 or email@example.com if you experience any problems, such as your Medical Assistance coverage ending or your MA services being reduced, denied or stopped.
As noted in other parts of this newsletter, the state has sought and received permission from the federal government to alter the ways MCOs (in Physical and Behavioral HealthChoices and Community HealthChoices) approve and deliver services. PHLP, for example, urged the state to temporary suspend prior authorization requirements for all benefits, including pediatric shift care services in the home. The Office of Medical Assistance Services (OMAP) has reported to PHLP that it is evaluating PHLP’s request and that it makes sense for some services and some populations. For example, the Physical Health MCOs were notified that they may not require a prior authorization for a CT scan of the chest when the patient has or is being tested for COVID-19.
PHLP will keep its website and readers of this newsletter updated. A link to the state’s COVID-related guidance to MCOs and providers is available here.
Are MA Providers Still Treating Patients?
They should. Medical Assistance (MA) MCOs are making sure their provider networks can handle an increase in health care services related to COVID-19. If an MA MCO does not have enough health care providers in its network with the appropriate training and experience to meet the health care needs of its members, MA MCOs must cover services by providers who are out-of-network. Consumers should call their MCO’s Member Services line (listed below) with any difficulty obtaining services. Consumers in the MA Fee-for-Service Program should call the Recipient Service Center at 1-800-537-8862 if they are having difficulty obtaining services.
If an MA MCO does not have enough health care providers in its network with the appropriate training and experience to meet the health care needs of its members during this pandemic, the MCO is required to cover services by out-of-network providers so that its members have what they need.
Can Consumers Still Rely on MATP for Transport to Non-Emergency Medical Care?
Yes. The Medical Assistance Transportation Program (MATP) continues to operate in every county in Pennsylvania. During the COVID-19 emergency, as with many services, consumers should be prepared for more limited availability due to challenges securing Personal Protective Equipment (PPE), limited availability of drivers, and similar emergency-related issues.
Despite potential challenges with transportation during the emergency, MATP should continue to provide vital services to individuals who need to get to non-emergency medical appointments, such as doctors, dentists, physical therapy, pharmacies, drug and alcohol clinics, mental health providers, outpatient rehab services, dialysis clinics, and more.
To arrange for transportation using MATP, call your local county MATP provider. If you have trouble getting transportation through MATP during the COVID-19 emergency, call PHLP’s Helpline at 1-800-274-3258.
Will MA Pay for Doctor Visits Delivered Through Telehealth?
Yes. Because COVID-19 is a communicable disease, you may prefer to receive health care services using telehealth instead of in-person. Telehealth is two-way, real time interactive communication between you and your doctor or other practitioner. Some services (e.g., primary care, chronic disease management, mental health) may be available using telehealth. You can contact your MA-MCO to see what telehealth services may be available.
The state has strongly encouraged the use of telehealth visits for all MA consumers in Fee-for-Service and MCOs. Additionally, all MCOs offer a 24/7 nurse phone line available for consumers to consult with various health-related questions. The Office of Long-Term Living has also encouraged providers to use telehealth and telemedicine broadly, including for assessments which otherwise take place in-person at an individual’s home.
The Office of Mental Health and Substance Abuse services (OMHSAS) has issued guidance expanded existing mental and behavioral telehealth services to include treatment provided by a number of providers including Certified Registered Nurse Practitioners (CRNPs); Physician Assistants (PAs) certified in mental health; Licensed Clinical Social Workers (LCSWs); Licensed Professional Counselors (LPCs); and Licensed Marriage and Family Therapists (LMFTs). Previously, only Psychiatrists and licensed Psychologists could provide behavioral health via telehealth services. Additionally, individuals may now use telehealth directly with their providers by way of smart phones and other electronic devices.
Does The COVID-19 Crisis Change My Access to Prescription Drugs?
Your access to prescriptions should improve. The state notified MA MCOs that they must allow their members to obtain early refills of all prescriptions at the pharmacy during the COVID-19 emergency period. This includes early refills for opioids for pain management and medication-assisted treatment for opioid use disorder. The prior authorization requirement based on day supply for short-acting opioids remains in effect. MCOs can authorize prescription for longer than normal durations when medically necessary during the COVID-19 pandemic.
Has Service Delivery Changed in Community HealthChoices?
Yes. The Office of Long-Term Living (OLTL) requested and received approval from federal officials to amend its Community HealthChoices program. We’ve highlighted below some of the most significant impacts on service delivery to Participants:
No Reductions of Waiver Services: The state has instructed CHC-MCOs not to reduce or terminate all waiver services, including personal assistance, for the next three months. Services on participants’ Person Centered Service Plan may not be reduced except when requested by the participant or their representative. However, providers should be given flexibility to ensure delivery of crucial, life-sustaining services and if necessary, delay less crucial services such as laundry and changing linens.
- Staffing and Service Delivery: Spouses, legal guardians and person with powers of attorney can now serve as paid direct care workers for participants when scheduled workers are not available due to COVID-19. This applies to consumers under BOTH the agency model AND the consumer-directed model. While spouses, legal guardians and powers of attorney must still undergo criminal background checks and child abuse clearances, they can be reimbursed for services while those clearances are pending.
- Comprehensive Needs Reassessments may be conducted remotely using phone or video conferencing when a participant’s needs change, when the participant requests a reassessment, or following trigger events. The qualifications for the individuals conducting these assessments will not change.
- Monitoring of the Service Plan: Service Coordinators may monitor participants and service plans remotely by telephone where face-to-face contacts are currently required. Service Coordinators are encouraged to contact participants frequently to ensure participants’ needs are being met during this emergency.
- Person-Centered Planning Team (PCPT) meetings and plan development may be conducted entirely using telecommunications. Members of the PCPT may also participate remotely using phone or video conferencing and are determined at the discretion of the participant.
Where Can I Go For Help And More Information?
Consumers with questions about COVID-19, including testing and related services, should call their Medical Assistance insurer for additional information. Those enrolled in Fee-for-Service (ACCESS) should contact the Fee-for-Service Recipient Call Center at 1-800-537-8862 (Select Option 1, then Option 2). Consumers enrolled in a Managed Care Organization should contact their MCO’s member/participant services line. We’ve listed the contact numbers for physical HealthChoices and Community HealthChoices plans below:
- Aetna Better Health: 1-866-638-1232
- Keystone First: 1-800-521-6860
- AmeriHealth Caritas PA: 1-888-991-7200
- Keystone First CHC: 1-855-332-0729
- AmeriHealth Caritas CHC: 1-855-235-5115
- PA Health and Wellness: 1-844-626-6813
- Gateway Health Plan: 1-800-392-1147
- United Healthcare: 1-800-414-9025
- Geisinger Health Plan: 1-855-227-1302
- UPMC for You: 1-800-286-4242
- HealthPartners Plan: 1-800-553-0784
- UPMC CHC: 1-844-833-0523
Here is a link to a comprehensive listing of MCO contacts.