PA Medicaid System Error Sending Conflicting Eligibility Notices: Appeal Right Away to Protect Your Coverage
Many people across Pennsylvania are receiving multiple Medicaid eligibility notices with the same mail date that contain completely different messages. You might get one notice saying you no longer qualify for Medicaid (Medical Assistance or MA), and another saying you continue to qualify for coverage. Unfortunately, the notice saying you continue to qualify is most likely an error.
What’s Causing This?
At the July Medical Assistance Advisory Committee (MAAC) meeting, the Pennsylvania Department of Human Services (DHS) confirmed that a system glitch is causing these erroneous mailings. They are still investigating the problem to figure out a solution. We will provide additional updates as the situation develops.
What To Do: Appeal Right Away
If you receive a notice saying you no longer qualify for Medicaid and you disagree, file an appeal right away—even if you also received another notice saying you continue to qualify.
Your eligibility notice should include:
- A Fair Hearing Request Form
- Instructions on how to file your appeal
To appeal, complete the Fair Hearing Request Form and submit it at your County Assistance Office (CAO). Be sure to ask for a receipt. You can also mail the appeal to the CAO using certified mail and requesting a return receipt. For more information on how to appeal, see our step-by-step guide here.
If you appeal quickly--within 15 days of the mail date on your notice--your Medicaid coverage will stay in place during the appeal. This allows you to work with the CAO to address any eligibility problems, like missing paperwork, without having a gap in your coverage. If it turns out the notice saying you no longer qualify was sent in error, you can withdraw your appeal later. Do not withdraw any appeal until you get written confirmation that you continue to qualify. Be sure to keep detailed records and notes—write down the date and time of any phone calls, who you spoke with, and what they told you.
Need Help?
If you need help with a Medicaid denial or other eligibility issue, contact the Pennsylvania Health Law Project (PHLP) at 1-800-274-3258 or staff@phlp.org, or the Pennsylvania Legal Aid Network (PLAN) at 1-800-322-7572 (you can also use this search tool to find your local PLAN program).
Key Takeaways
- System glitches or errors shouldn’t put your health coverage at risk.
- If you aren’t sure about your Medicaid status or you have received conflicting notices, the safest approach is to file an appeal immediately.
- You can always withdraw your appeal later if it becomes unnecessary.
- Legal advocates are available to help!
