593K Pennsylvanians may no longer be eligible for Medicaid as COVID emergency ends
When President Joe Biden’s administration sunsets the national and public health emergencies for COVID-19 this spring, it will mark the end of flexibility the federal government extended to keep people continuously insured under Medicaid throughout the coronavirus pandemic.
According to the Kaiser Family Foundation, between 5 million and 14 million people could lose their Medicaid coverage after the twin emergency declarations end May 11.
As of September, total Medicaid enrollment grew to more than 90 million people nationwide, the KFF reported.
According to eligibility guidelines available at Medicaid.gov, individuals from certain groups are automatically eligible for Medicaid, including low-income families, qualified pregnant individuals and their children, and people receiving Supplemental Security Income. States have the option of adding others, such as children in foster care or people receiving social services.
In Pennsylvania, the Department of Human Services estimates hundreds of thousands of state residents will be affected by this change.
We asked the agency what will change for low-income Pennsylvania families covered under Medicaid and how DHS is planning for this transition. Here’s what to expect in the coming months if you or a loved one is covered by Medicaid.
What does this mean for Medicaid recipients in PA?
In an email response to several questions, Pennsylvania DHS press secretary Brandon Cwalina wrote much of the change hinges on legislation signed into law by Biden late last year.
Ultimately, Biden’s signature on the Consolidated Appropriations Act means states across the country will no longer be required to continuously cover Medicaid recipients, which was a provision of the public health emergency.
A key date arrives in late March, Cwalina wrote in his response.
“The continuous coverage requirement will end on March 31, 2023,” he wrote. “On April 1, 2023, states are expected to resume pre-COVID-19 processes for [Medicaid] and Children’s Health Insurance Program (CHIP) renewals, eligibility determinations, and disenrollments where necessary,” Cwalina added.
Cwalina underscored Medicaid recipients’ coverage won’t lapse automatically once April arrives.
“We want to be clear: cases will not automatically close on April 1, 2023. On that date, [The Pennsylvania Department of Human Services] will resume typical processes for [state Medicaid] and CHIP eligibility determinations, but coverage will not automatically end on April 1. All recipients will have the opportunity to complete a renewal over a 12-month period,” Cwalina wrote.
How many PA residents will be affected by this change?
The DHS spokesman said as of December, the agency identified roughly 593,000 individuals who remained on Medicaid without meeting eligibility requirements.
Cwalina further added that about “577,000 individuals, some of whom were already found to not be meeting eligibility criteria, have not completed the renewal process since the [public health emergency] was put in place.”
The spokesperson said in Centre County as of December, up to 4,023 individuals may be ineligible based on their last Medicaid renewal, and 1,389 residents have not completed their most recent renewal.
What should PA Medicaid recipients expect this spring?
Once the continuous eligibility requirement sunsets, Medicaid recipients will be sent a new renewal notice.
“If they do not return the renewal or if they do not meet eligibility criteria, these cases will close after proper notice,” Cwalina said. “Our focus is to ensure that Pennsylvanians have no lapse in quality, affordable health care.
“If a person is financially ineligible for continued coverage, DHS will provide direct referrals to other sources of affordable medical coverage like CHIP and Pennie, Pennsylvania’s state-based insurance marketplace,” Cwalina wrote.
Cwalina wrote that “these individuals will be able to access the marketplace. A loss of coverage is considered a ‘Qualifying Life Event’; the Pennie website has a video explaining qualifying life events.”
Will Medicaid continue to cover at-home tests for COVID-19 in PA?
Yes. As confirmed by Cwalina, Pennsylvania’s Medicaid program will continue to cover at-home tests for COVID-19 after the public health emergency ends in May.
However, if you participate in a managed care organization, you may need a prescription from your doctor.
Cwalina added that medications approved by the U.S. Food and Drug Administration under its emergency-use provisions will also continue to be covered as long as the agency continues the emergency-use approval. This includes the antiviral COVID-19 treatment drug Paxlovid, for example.
How will coverage for telehealth services change for Medicaid recipients?
Cwalina stated DHS does not anticipate any changes to Medicaid coverage for physical or behavioral telemedicine services after the end of the public health emergency.
Telemedicine’s popularity has risen during the coronavirus pandemic. As reported by U.S. News, willingness to use video telehealth increased overall from 51% in February 2019 to 62% in March 2021, according to a survey of 1,600 adults.
This story may be updated.
This story was originally published February 10, 2023 at 6:00 AM.