Under orders issued by a federal judge in January and March 2023 in the case Carr v. Becerra, the Pennsylvania Department of Human Services (DHS) was required to reinstate full Medicaid to Pennsylvanians with Medicare who lost Medicaid during the COVID public health emergency. However, DHS’s plans to systematically restore coverage for the impacted population has not come to fruition, meaning most people whose Medicaid was supposed to be restored still do not have coverage. Because of the delays, DHS is now agreeing to restore Medicaid for people covered by the Carr orders upon request.
The Carr case successfully challenged a Trump-era regulation that had resulted in tens of thousands of people losing Medicaid coverage in violation of the Families First Coronavirus Response Act (FFCRA) requirement that states keep people on Medicaid during the COVID crisis. The Carr court certified a nationwide class of people who were or would be harmed by the now enjoined regulation. That class consists of all individuals enrolled in Medicaid on March 18, 2020 or later through March 31, 2023 whose Medicaid was reduced to a Medicare Savings Program only. Medicare Savings Programs (called “Buy-In” in Pennsylvania) pay the Medicare Part B premium and may cover Medicare Part A and B out-of-pocket costs.
In April 2023, DHS prospectively restored Medicaid to approximately 8,800 Pennsylvanians whose coverage had been reduced under the regulation the court found was illegal. Surprised at what we saw as a low number of individuals being reinstated to Medicaid, PHLP audited cases of our past clients who had Medicaid reduced under the Trump rule and conclude that DHS likely had missed a substantial number of people. We documented and shared our findings with DHS who investigated and subsequently identified approximately 23,000 more Pennsylvanians whose coverage needed to be restored.
Because of the large number of additional individuals needing restoration of Medicaid and an even larger number who needed Medicaid reinstated retroactively to cover past gaps in Medicaid during the COVID crisis, DHS planned to systematically resolve the coverage issues in mid-October. However, the agency’s Information Technology (IT) vendor is now reporting coverage will not be restored until sometime in December. Because of the additional delay, DHS agreed to prospectively restore Medicaid for those who ask to have their coverage back, so they do not have to wait until December or later.
Below is information to help identify who is affected by the Carr order, who should expect their Medicaid to be reinstated and what to expect in the coming months.
Who is supposed to benefit from the Carr orders?
- People who were on full Medicaid at any point between March 18, 2020 and March 31, 2023, but were reduced to a Medicare Savings Program/Buy-In benefit only.
- People who were in the Qualified Medicare Beneficiary (QMB) program between March 18, 2020 and March 31, 2023 but were reduced to a Medicare Savings Program that only pays the Medicare Part B premium. QMB pays the Medicare Part B premium as well as Medicare Parts A and B cost sharing.
What do the Carr orders require?
People whose Medicaid or QMB was reduced are supposed to have their coverage restored until their first full Medicaid renewal following the COVID-19 Unwinding. Everyone who lost Medicaid and QMB is also supposed to have Medicaid (or QMB) restored retroactively to when their coverage was first reduced. Some people were able to get their Medicaid restored going forward before the Carr orders, but might still have gaps in Medicaid coverage from the past that need filling.
Who should ask DHS to restore their Medicaid/QMB coverage now?
Anyone who was on Medicare and Medicaid, had their Medicaid (or QMB) reduced between March 18, 2020 and March 31, 2023, and did not already have a Medicaid renewal since April 1, 2023. DHS estimates this to be about 14,000 people.
People whose Medicaid was reduced under the now illegal Trump rule, but who already had a full renewal of their Medicaid since April 1, 2023 are not eligible to have Medicaid restored unless they reapply and are found otherwise to be eligible for Medicaid.
How can people ask to have their Medicaid/QMB restored?
We understand that people eligible to have their Medicaid restored will receive a letter the first week of November with instructions. We expect the instructions to tell people to call the DHS Customer Service Center at 1-877-395-8930 or in Philadelphia call 1-215-560-7226. The Customer Service Centers should have a list of people whose Medicaid eligibility can be restored.
How long will the restored Medicaid last?
People whose Medicaid is restored will keep Medicaid until their first Medicaid renewal after April 1, 2023. At their renewal, they will be reevaluated to see if they still qualify for the restored level of Medicaid coverage. If they do not, the coverage will be reduced or terminated. They will receive a notice with appeal rights.
What happens if someone is eligible to have Medicaid restored but does not request it?
In December, DHS intends to restore Medicaid for people covered by the Carr decisions who did not already have a Medicaid renewal since April 1, 2023. However, since restoration of Medicaid has already been delayed twice, PHLP strongly recommends that people ask to have their Medicaid restored instead of waiting.
When will people who have past paid and unpaid medical bills get retroactive Medicaid/QMB?
Right now, people covered by the Carr orders are only able to request their Medicaid be restored going forward. But tens of thousands of people have gaps in their Medicaid coverage that the Carr court also required to be filled. DHS hopes retroactive Medicaid will be restored in December. At that point people will be able to ask their providers to bill Medicaid for past bills (paid and unpaid). PHLP will provide updated information when it becomes available.