On January 31, 2023, a federal judge in the case Carr v. Becerra ordered the U.S. Department of Health and Human Services to stop enforcing 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 also 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 whose Medicaid was reduced from full Medicaid coverage 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.
The effect of the judge’s order in Pennsylvania is that the Pennsylvania Department of Human Services (DHS) has stopped reducing Medicaid coverage through March 31, 2023 for people who are also on Medicare. In addition, DHS is retroactively reinstating full Medicaid coverage for people on Medicare whose Medicaid was previously reduced because of the illegal Trump-era rule. These reductions began in November 2020 when the now illegal rule took effect. Those whose coverage will be restored include:
People who were on full Medicaid but were reduced to a Medicare Savings Program/Buy-In benefit only; and
People who were in the Qualified Medicare Beneficiary (QMB) program, a Medicare Savings Program that pays Medicare premiums and cost sharing, but were reduced to a Medicare Savings Program that only pays the Medicare Part B premium.
DHS has informed advocates that people whose Medicaid is reinstated as a result of the Carr decision will get notice that their full Medicaid benefits have been reinstated. We expect notices to go out in April. DHS also said that these individuals will keep their reinstated Medicaid coverage until their next regularly scheduled renewal.
Unfortunately, the judge’s order does not cover other populations, such as certain young adult immigrants and formerly pregnant immigrants, whose Medicaid was also unlawfully reduced or terminated due to the Trump-era rule.
PHLP will provide updates on DHS’ compliance with the Carr order. In the meantime, people on Medicare whose Medicaid benefits were reduced between November 6, 2020 and March 31, 2023 should look out for notification from DHS that their Medicaid is restored. If someone believes their Medicaid should be restored, but it is not, please call the PHLP Helpline at 1-800-274-3258.