That pandemic pause on Medicaid eligibility rule is about to end
The further away we get from the height of the COVID-19 pandemic, the more we are reflecting on how things have changed, for better or worse (seemingly, worse). There were extraordinary changes implemented in many aspects of our lives, and not necessarily by choice. One of these that affects millions of Pennsylvania residents using Medicaid is about to expire at the end of this month.
Medicaid (called Medical Assistance in Pennsylvania) is a vital program supporting young and old recipients in need of continuing long term care. As elder law attorneys, we know that the majority of our clients rely upon Medicaid coverage for skilled nursing home care or home and community based services.
On April 1, the Pennsylvania Department of Human Services will be able to terminate recipients of Medicaid services for the first time in several years.
Shortly after the pandemic began, federal law allowed DHS to ease its scrutiny of Medicaid recipients’ lives so that basically no one could be kicked off the program.
This meant the department was not checking on recipients’ financial information to determine ongoing eligibility.
The recently enacted Consolidated Appropriations Act of 2023 sets a deadline of April 1, 2023, for DHS to reinstate its eligibility controls.
Prior to the pandemic, the department would send out annual notices and informational requests to Medicaid recipients to maintain eligibility. Starting next month, DHS will begin sending out renewal notices again. The Medicaid recipient had better respond or risk losing program benefits.
According to DHS’ website, “Renewals will take place over 12 months, and no one will be disenrolled without having a chance to complete a renewal.”
There are four ways to complete your renewal.
By mail: Complete and return the forms by mailing them back in the provided envelope.
Online: Complete your renewal online at COMPASS (www.dhs.pa.gov). Telephone: Call 1-866-550-4355. In person: Visit any local County Assistance Office
While most of the information provided by the government and other commentators on reinstatement of annual Department of Human Services renewals has focused on the renewal submission process, that step is just the beginning of what could potentially be a long journey for Medicaid recipients.
Previously, a recipient would provide annual financial information to maintain eligibility. If a Medicaid recipient disclosed excess financial resources or the gifting of an asset during the prior year review period, a penalty period or loss of benefits could result.
Fast-forward to April 2023 and throughout the next 12 months of review. Say a Medicaid recipient received an inheritance of $25,000 in 2021 and gave it to his children shortly thereafter who were laid off from work because of the pandemic. The monies were given so that they could pay their mortgage and other creditors. In a pre-COVID world, this type of transaction would be penalized by the Department of Human Services, which could result in a loss of Medicaid benefits equal to the amount gifted away. In a post-COVID world, we will just have to wait and see if the department carves out any hardship exceptions. From a legal perspective, the department’s hands are somewhat bound to federal law, which requires the penalizing of a gift by a Medicaid recipient or applicant without there being a specific exemption to permit it. Furthermore, while this reinstatement of annual renewals is necessary, it is a logistical nightmare for the Department of Human Services if it plans to “pick up where it left off,” which means that its staff will be reviewing roughly three years of financial transactions per Medicaid recipient instead of just one. In addition, Medicaid eligibility is not just a financial or DHS issue. Many agencies are involved such as Pennsylvania’s 52 Area Agencies on Aging, which are part of P4A (www.p4a.org).
Rebecca May-Cole, executive director of P4A, said, “The Area Agencies on Aging are prepared to support older adults in their communities throughout the Medicaid unwinding process. The AAAs are available to provide education and resources to older adults as they complete their Medical Assistance renewal documents. Our goal is to ensure older adults continue to receive Medicaid as a supplement to their Medicare benefits, SNAP food benefits, and transportation needs.”
The important thing to remember is that this process will be very time sensitive. If you receive a renewal request, complete and return it immediately.
Even more importantly, if you then receive a denial notice and feel that it is inaccurate, you must file an appeal quickly to preserve eligibility in the Medicaid program.