During the COVID-19 pandemic, most Medicaid recipients were not allowed to lose their insurance coverage and did not need to renew their benefits. However, these COVID-era protections ended in April 2023. DHS is now reviewing all Medicaid recipients during their yearly renewal period to determine whether or not they remain eligible. PHLP has heard from many people who have lost their Medicaid now that renewals are happening again. This article contains non-Medicaid options for health insurance for those who no longer qualify for Medicaid.
It is important to submit all necessary and requested information to your County Assistance Office (CAO) when your Medicaid renewal is due. If you submit all required documents with your renewal and receive a letter telling you that your Medicaid is ending, you still have options for health coverage! Below is a list of options for Medicaid recipients who are losing their benefits due to no longer qualifying:
- Appeal the Medicaid Termination: You are entitled to receive 15 days advance notice before your Medicaid is terminated. That denial notice comes with appeal rights. If you file your appeal within 15 days of the denial notice, your Medicaid coverage will continue throughout the appeal process. If you file your appeal after the 15-day deadline, you can still appeal and have a hearing, but your benefits will not continue during the appeal. Contact PHLP’s Helpline at 1-800-274-3258 for help with the appeal.
- File Reconsideration: If your renewal was denied due to missing documentation, you can ask for Reconsideration within 60 days of the denial date. The Reconsideration process allows you to provide the missing documentation and have your renewal re-reviewed, instead of needing to reapply for Medicaid. It is best to ask for Reconsideration in addition to filing an appeal (above).
- Purchase Coverage Through Pennie: If your Medicaid benefits are stopped because your income is too high to qualify, Pennie is an affordable and comprehensive option for health coverage. Pennie is Pennsylvania’s state-based health insurance marketplace. To qualify for Pennie, you must be ineligible for Medicaid. To see if you qualify for Pennie coverage, call Pennie at 1-844-844-8040 or visit their website.
- Explore Medicare Coverage Options: If you recently became eligible for Medicare, you could no longer qualify for certain categories of Medicaid. Contact PA MEDI (formerly APPRISE) at 1-800-783-7067 for free Medicare counseling and advice. They can assist you with finding affordable coverage in the Medicare system.
If you have questions about Medicaid eligibility or you receive a termination or denial notice, please contact PHLP’s helpline at 1-800-274-3258.