Medicaid Now Covers COVID-19 At-Home Test Kits
As of mid-February, all Medicaid recipients in Pennsylvania should have access to free over-the-counter COVID-19 test kits. Medicaid covers up to eight tests per month, and no doctor’s prescription is required.
State Medicaid officials reported in late January that at-home COVID-19 tests had been added to the Medicaid fee schedule (list of covered services) and were now available to recipients in Fee-for-Service Medicaid, also known as Medical Assistance. This MA Bulletin describing the parameters of the coverage was published on February 1, 2022. It suggests that consumers should be able to obtain coverage for tests purchased all the way back to August 30, 2021.
All of the Medicaid managed care plans (MCOs) implemented coverage of the new benefit by mid-February, according to state officials. The MCOs all cover up to eight tests per month, though some limit the coverage to two tests per week or two tests per pharmacy visit. (This item is typically packaged as two tests per box.) Members who are homebound should contact their pharmacy or MCO member services to request home delivery.
Because Medicaid coverage of OTC COVID tests is retroactive to August 31, 2020, recipients who have paid out of pocket for these items can request reimbursement. Recipients in fee-for-service MA can use their receipts to request reimbursement from the pharmacy where they purchased the tests. Recipients in MCOs should contact their managed care plans to request reimbursement.
For information on coverage of OTC COVID test kits by private health insurance companies, see this PHLP article and this CMS Frequently Asked Questions document.