End of pandemic-era policy presents dilemmas for millions of Pa. Medicaid, CHIP recipients

For 3.6 million Pennsylvanians enrolled in Medicaid, the next few months will be a race against the clock to keep their health insurance coverage or a scramble to find a new option.

During the pandemic, Pennsylvania and other states were able to continue Medicaid and Children’s Health Insurance Program (CHIP) coverage for most recipients through the covid-era Families First Coronavirus Response Act, even if they no longer met eligibility requirements.

But, because of a federal law passed in December, that extension is set to end April 1, meaning all Medicaid and CHIP recipients will need to complete an annual renewal to see if they still are eligible for coverage.

For Medicaid recipients, the transition could mean a major change in their health insurance coverage, said Amy Lowenstein, director of policy and supervising attorney with the Pennsylvania Health Law Project, a legal aid group that assists with health coverage issues.

“There was a law passed by Congress that allowed the states to keep people on Medicaid so they would have access to health insurance even if they might not be eligible anymore or if they forgot to send in a renewal,” Lowenstein said. “We always knew it wouldn’t be permanent, but what is going to happen on April 1 is that is the first time the state is going to be allowed to disenroll people from Medicaid since that law passed.”

April 1 likely will not be the first time Medicaid recipients hear about the change, and termination of coverage won’t be instantaneous, she said. But, as the deadline looms, health advocacy groups are hurrying to prepare patients to renew or seek other care.

Moving to different coverage

Lowenstein expects outright Medicaid denials won’t be sent until later in April at the very earliest. Recipients will receive paperwork for renewals, which correlate to when they originally enrolled in Medicaid. The state will not have to handle millions of renewals at the same time, she said.

“We want the state to have the capacity to handle all of the renewals. If they were to do them all at once, the system wouldn’t be able to handle it,” she said. “It is really one year to reevaluate everybody’s eligibility, and then, if people are not eligible anymore, they will get a notice.”

While some Medicaid recipients will be evaluated and found still to qualify, others will not and will need to seek out different coverage options, such as Medicare for older adults, the Children’s Health Insurance Program (CHIP) for kids or Pennie, Pennsylvania’s official health and dental coverage marketplace.

“We want to make sure (that if) their Medicaid is terminated that they find their way to other health insurance, like Pennie and Medicare,” Lowenstein said. “We really want people to get there and get there seamlessly.”

Pennie already has posted some information online for people who receive Medicaid and are concerned they might lose coverage. The webpage advises recipients to update contact information with the Pennsylvania Department of Human Services and to watch for mail, emails and texts from DHS.

At Highmark Wholecare, Director of Health Choices Joe Glinka expects upwards of 80,000 people on the Medicaid plan in the Southwest and Lehigh/Capital regions no longer will qualify.

“When you look across all medical systems in Pennsylvania, you’re looking at over 500,000 lives that would be impacted by the redetermination normalization process,” he said. “We are doing everything we can to inform them of things to come, and we’re working collaboratively.”

Administrative churn

The potential that Medicaid recipients might miss communication from the DHS or neglect to send renewal forms is a major worry for advocates, Lowenstein said.

“That is our biggest concern — that people who are still eligible will be terminated and not find out until they go to the doctor, and the doctor or pharmacist tries to bill Medicaid and it is rejected,” she said. “Many things cause that to happen: They didn’t get documentation in (on) time; they didn’t fill out the forms correctly. There could be overloads of the system if there’s a lot of documentation coming in at once.”

The cycle of eligible recipients falling between the cracks and having to reapply, referred to as “administrative churn,” also makes more work for state caseworkers and clogs the process, she said.

“We think it’s going to be thousands upon thousands of people who will have to go through this,” Lowenstein said. “That’s a huge concern. That means loss of access to health care for people who really should be on (the rolls).”

Children’s eligibility

About 430,000 children who are enrolled in Medicaid are at risk of losing coverage, according to Carolyn Myers, spokesperson for the children’s advocacy organization Pennsylvania Partnerships for Children. They can enroll in CHIP if they lose coverage but run the risk of being lost in the shuffle, she said.

“Our concern is that cliff, because, for us, one child without health insurance is too many,” Myers said. “There’s a lot of things that can be done now. Like I said, it’s a good thing that the administration is committed to taking that 12-month runway, but another thing they could do is ensure there is continuous eligibility.”

Pennsylvania Partnerships for Children has asked the state government to extend the continuous enrollment for an additional year for children between 4 and 21 to bridge potential gaps.

“That will protect children from losing health insurance, even if temporarily, while providing peace of mind for parents and lightening the administrative burden on caseworkers,” Myers said.

Renewal processes

When Thelma Jackson, program director of Healthy Start in Allegheny County, meets with local residents at health clinics and community centers to talk about the upcoming Medicaid changes, she’s often met with more than a bit of shock.

“Everybody seems to be surprised,” she said. “It is my job to make them realize that this is a process that people are going to need some assistance with come April.”

Healthy Start, which works with new parents to promote maternal and child health, has partnered with Pennsylvania Health Access Network, a statewide organization that assists approximately 10,000 people annually with health insurance through a helpline. The two organizations are working locally as “boots on the ground” to spread information about the April 1 change.

“I don’t think people really know about the redetermination that is coming in April,” she said. “That is why I’m going out in these various communities, trying to get the word out and raise awareness that (there is) a program that can help them with their renewal process.”

Medicaid renewal might be a new challenge for many people who have never had to do it before, said Patrick Keenan, policy director at the Pennsylvania Health Access Network.

Keenan described the upcoming Medicaid transition as “a really big event.”

“For many individuals, this may be the first time they (have been) asked to complete a renewal,” he said. “For many county assistance offices, many of their employees, this is the first time they have gone through these large-scale renewals. It’s going to be a challenge, both for the people who are renewing their benefits as well as the workers who are processing the renewals.”

The network has started talking with Medicaid recipients and urging them to update their contact information and addresses with the state. Keenan says the organization has seen an increase in calls to its free helpline as people hear about the upcoming changes. He expects the calls to climb further as April approaches.

“We are really going to be helping and ready to help people understand what their income is, how to make sure that their renewal info is complete as possible, and ready to work through any problems that they might have,” Keenan said. “We see a lot of individuals that, through a paperwork error or incorrect computer calculation, get a notification that terminates them from their benefits wrongfully.”

Anyone looking for help with renewals can call the network’s free helpline at 877-570-3642, he said

“I think that people are really confused,” Keenan said. “It’s really important that they take time to calculate their income correctly, that they get some help in kind of figuring these things out.”