As detailed in January, the County Assistance Offices (CAOs) will begin terminating some people from Medicaid beginning on April 1, 2023. For three years, many people no longer eligible for Medicaid were maintained on coverage due to the pandemic and the federal declaration of a public health emergency. The Medicaid continuous coverage provision of the public health emergency is ending because of the federal Consolidated Appropriations Act signed into law in December 2022.
What Do Medicaid Recipients Need to Know?
Medicaid will not be terminated before a renewal is completed. The County Assistance Offices must first mail a renewal packet for completion before anyone’s Medicaid might be terminated.
All Medicaid recipients no longer eligible for Medicaid will not be terminated at one time. Pennsylvania will take 12 months to review the entire PA Medicaid population. This 12-month period is called the “unwinding” period. Most Medicaid recipients will have their renewal when they generally do each year.
What Do I Need to Do if I am on Medicaid?
- If you moved in the past three years and have not notified the County Assistance Office, do so right away! Medicaid recipients can contact the County Assistance Office or call the Customer Service Center at 1-877-395-8930 (in Philadelphia, call 215-560-7226) to provide updated address information. If you have an online COMPASS account, you can also update your address there.
- If your phone number has changed in the last three years and you have not notified the CAO, notify them or the Customer Service Center right away. (Or update on COMPASS).
- Watch the mail closely for the renewal packet from the CAO and respond to it quickly. You will begin getting notices 90 days before your renewal is due. You can also sign up to receive text alerts about your renewal.
- Return the renewal packet by the deadline provided. Just like prior to the pandemic, Medicaid recipients who do not return a completed renewal packet with the required documentation will receive a termination letter from Medicaid. If you have problems getting any documents requested with the renewal packet such as paystubs, contact the CAO right away for assistance.
What I Need to do if my Coverage is Terminated?
Individuals terminated from Medicaid will receive a denial notice from the CAO. Individuals terminated from Medicaid who believe they are still eligible should first appeal right away. Appealing timely will keep Medicaid in place during the appeal process. Then, ask the CAO for "Reconsideration" while you complete the renewal packet and provide all requested documentation to CAO. Reconsideration can be requested within 90 days without having to submit a whole new Medicaid application.
Click here for the DHS frequently asked questions/FAQ about the end of continuous coverage.
If you are no longer eligible for Medicaid (and you do not have Medicare), you may be able to enroll in other affordable health insurance with Pennie, Pennsylvania’s state-based health insurance marketplace. Pennie 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. Individuals needing help enrolling in Medicare can contact the PA MEDI Program. Individuals with Medicare and Medicaid who are no longer eligible for Medicaid can also get help from PA MEDI to explore Medicare Advantage plans.
Kids under 19 who are no longer eligible for Medicaid due to household size and income should have their information forwarded to the Children's Health Insurance Program (CHIP).
Pennsylvania Health Law Project will continue to provide updates on the Medicaid unwinding.