Medicaid Protections During Pandemic Extended & Changed

In early January, the U.S. Department of Health and Human Services renewed the federal Public Health Emergency (PHE) declaration based on the coronavirus pandemic, which was set to expire in late January 2021.  This extends the federal PHE – and important Medicaid protections in place in Pennsylvania based on this authority – until at least April 20, 2021. 

1. Continuous Coverage

The Families First Coronavirus Response Act requires states to provide continuous coverage for all Medicaid beneficiaries until the end of the month in which the federal PHE declaration ends.  This means that most people on Medicaid must continue to receive Medicaid through April 30, 2021, even if they are no longer eligible.  States can only close a person’s Medicaid coverage at their request or based on certain narrow exceptions to the continuous coverage rule.   

However, Pennsylvania’s Department of Human Services (DHS) published new guidance last month that expands the exceptions under which DHS can stop a person’s Medicaid.  DHS will now stop the benefit where coverage was opened through fraud or by agency error.  It will also stop coverage for certain Medicaid consumers who now qualify for Medicare and the state’s Medicare Buy-In program.  New Medicare beneficiaries who would not qualify for Medicaid but for the pandemic protection will now be moved to the Medicare Buy-In program.  If they do not qualify for Buy-In, DHS will maintain their Medicaid until the continuous coverage protection expires.   

2. Pediatric Shift Nursing “Freeze” 

The extension of the federal PHE also allows Pennsylvania to continue administrative flexibilities like the protections currently in place for pediatric skilled nursing services.  As one of many temporary changes approved through Section 1135 waiver authority, DHS in early April 2020 removed prior authorization requirements for many services and effectively “froze” existing authorizations for in-home pediatric skilled nursing services.  Any shift nursing requests newly approved since April 2020 are also covered by these protections.  State officials have confirmed in public meetings that DHS will continue the shift nursing protection for as long as the federal PHE remains in effect.   

3. Beneficiaries Turning 21 Will No Longer Retain Benefits Available to Children  

State officials recently announced that DHS will stop maintaining the “child” benefit package for young adults who turn age 21 on February 1, 2021.  This follows a change in how federal authorities interpret the Family First Coronavirus Response Act.  We had reported that states, including Pennsylvania, were required to maintain beneficiary benefit levels during the federal PHE.  However, because of this policy change starting February 1st, young adults turning 21 will no longer have access to services such as private duty shift nursing and should receive a letter from DHS describing the change.  If they have not transitioned into Medicaid waiver already, young adults who need long term care services (like personal care or shift nursing) in the community should apply for a Medicaid waiver program.   

Please contact PHLP’s Helpline at 1-800-274-3258 (or email with any questions or if you need legal assistance maintaining these essential supports.