Medicaid Unwinding in Pennsylvania: What You Need to Know
Key takeaways:
Medicaid in Pennsylvania is changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. During this time, some people will lose Medicaid coverage during a process called the unwinding.
Medicaid renewals were automatic during the PHE, and enrollees had continuous coverage. As part of the unwinding, automatic Medicaid and Children’s Medicaid (CHIP) renewals will stop nationwide on March 31, 2023.
The Pennsylvania Department of Human Services (DHS) is reviewing all of the state’s Medicaid cases for eligibility. DHS needs to have your current contact information. If you can’t be reached or no longer qualify, you could be dropped from Medicaid as early as May 2023.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020, which was renewed a dozen times through February 2023.
Medicaid renewal changed during the PHE, and states were required to provide continuous coverage. So if you were enrolled during the 3 years of the PHE, there’s a good chance you didn’t lose your health insurance.
Now that the PHE is ending, states are beginning to figure out who is still eligible for Medicaid. This is known as the unwinding. Some people in Pennsylvania will lose coverage as soon as May 1, 2023.
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Why is Medicaid changing nationwide?
The PHE will end on May 11, 2023. When that happens, COVID-19 will remain a public health priority — but not an emergency. As part of that process, yearly Medicaid renewals will resume.
Medicaid renewals will change in every state, the District of Columbia, and five U.S. territories. That means millions of people nationwide risk losing Medicaid coverage.
What’s happening with Medicaid renewal in Pennsylvania?
Pennsylvania intends to take 12 months to review all 3.7 million Medicaid and Children’s Medicaid (CHIP) cases. Be sure that the Pennsylvania Department of Human Services (DHS) has your current contact information so you can be reached when your case is up for review.
You can update your contact information as well as renew your Medicaid by:
Logging into your COMPASS account on the self-service portal
Calling 877-395-8930 statewide
Calling 215-560-7226 if you’re in Philadelphia
Your correct contact information is important because DHS will send renewal packets for you to complete. Your Medicaid renewal date deadline will be on your packet. Your Medicaid could expire if you do not respond to the DHS before your renewal deadline.
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Here is a timeline of Pennsylvania's Medicaid renewal process:
90 days before renewal: DHS will send information about your Medicaid renewal. This will include a reminder to ensure your contact information is current.
60 days before renewal: You can renew online or by phone.
A month before your renewal: The DHS will mail you a renewal packet if you haven't responded online or by phone — or if the agency needs additional documents. You can bring the completed forms to a county assistance office or mail them to DHS.
What should I do if I lose my Medicaid coverage in Pennsylvania?
The Pennsylvania DHS may determine that you no longer qualify for Medicaid because:
Your income has risen above the state’s limit for Medicaid eligibility.
You have had a change in health status.
You’ve moved to a different state.
You’ve lost Social Security income.
You left or entered a long-term care facility, mental health treatment center, or prison.
It’s important to note that if you lose coverage but believe you qualify, you should reapply for Medicaid. If you are denied Medicaid coverage, the Pennsylvania DHS also allows you to appeal their decision. Directions for appealing are included on the Medicaid renewal information you receive.
You may be uninsured for a while if you reapply and wait to be approved again for Medicaid. In that case, you can consider free and low-cost healthcare options or use GoodRx coupons to save on your prescription medications.
If you don’t plan to reapply for Medicaid, you should see if you qualify for coverage elsewhere. Depending on your individual circumstances, you may be able to find health insurance with one of these options:
Affordable Care Act (ACA) marketplace: Pennie is the state-based ACA exchange. In this marketplace, you may be able to find a health plan for $10 or less per month if you qualify for a premium subsidy. Losing your Medicaid coverage will trigger an unwinding special enrollment period that will last from March 31, 2023, to July 31, 2024. This gives you a chance to purchase an insurance plan on the ACA marketplace.
Employer plan: You may now have a job that offers employer-sponsored insurance.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
Veterans Affairs: If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or Veterans Affairs benefits and services.
Pennsylvania Medicaid resources
Pennsylvania Medicaid office: Get general information about Medicaid by visiting the Pennsylvania Department of Human Services (DHS).
Pennsylvania Medicaid customer service: Call 877-395-8930 statewide and 215-560-7226 if you’re in Philadelphia to talk to someone about your Medicaid coverage.
Pennsylvania Medicaid and CHIP renewals: Read about how the state plans to review nearly 4 million cases in 12 months.
Pennsylvania Medicaid self-service portal: You can log in to your Medicaid account 24/7 through COMPASS to update your contact information and see the status of your health insurance.
Medicaid and CHIP renewal FAQs: Find answers to frequently asked questions about Pennsylvania’s process.
Renewal application help: Get Medicaid renewal application assistance by calling 866-550-4355.
In-person renewals: Locate the county assistance offices where you can drop off your completed forms.
The bottom line
Continuous coverage for Medicaid enrollees ended nationwide on March 31, 2023. Pennsylvania plans to spend a year reviewing more than 3 million cases. You may lose coverage as early as May 2023 if you no longer qualify.
It’s important that the Pennsylvania Department of Human Services has your current contact information so you can be reached for your case review. If you lose coverage, consider other health insurance options like a health plan from Pennie — the state’s Affordable Care Act exchange — or short-term insurance.
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References
Centers for Medicare & Medicaid Services. (2023). Unwinding and returning to regular operations after COVID-19.
Kilmer, L. (2023). Advocates raise concerns about Medicaid cut-offs. WPXI Now.
Pennsylvania Department of Human Services. (2023). Medical assistance & CHIP renewals.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
U.S. Administration for Strategic Preparedness & Response. (2020). Determination that a public health emergency exists.
U.S. Administration for Strategic Preparedness & Response. (2023). Renewal of determination that a public health emergency exists.
U.S. Department of Veterans Affairs. (2022). VA/DoD health affairs.
