Medicaid is still unwinding
On March 27, 2023, we discussed this topic in this column. You may recall from last year’s commentary that due to the COVID-19 pandemic, the government halted removing people from Medicaid eligibility until it was safe to declare the pandemic over in order to not deprive people of important healthcare coverage and other valuable benefits provided to millions of Americans who were already struggling because of COVID.
On April 1, 2023, the stay was lifted, and state Medicaid agencies began to re-examine eligibility across the states. In Pennsylvania, we have seen the effects of this reinstated policy, and we’re only about halfway through the process after a year. Let’s take a look at some of the statistics and real-world activities that have occurred and will continue to occur as the second half of this process ensues.
There is a wealth of statistical information on the PennsylvaniaDepartment of Human Services website. You can also find accurate national information for purposes of comparison here. According to DHS, the total Pennsylvania maintained population receiving Medicaid is slightly greater than 1.3 million. It is difficult to read the monthly statistics in real time for a variety of reasons. One major factor is that Medicaid recipients who are denied continuing coverage have a right to appeal that coverage, which can take several months to complete as we will discuss. Here are some categories to consider:
1. People who enroll simply as new Medicaid recipients for the first time.
2. People who dis-enroll because they die.
3. People who are already on Medicaid and continue to be eligible.
4. People who dis-enrolled because they were no longer eligible (usually because of financial thresholds or did not need the coverage anymore).
5. Procedural denials of continuing eligibility because a Medicaid recipient was given notice to respond to verify eligibility and did not respondin a timely manner.
Aside from the statistics, here are some examples of what we are seeing in the legal practice of elder law advocacy:
1. People are receiving notices from DHS to verify their eligibility. However, they either never receive the notice (sent to an address no longer maintained by the Medicaid recipient) or they simply don’t understand the time sensitive nature of responding and then lose their eligibility. This is difficult as a person may need assistance on a daily basis or have a cognitive disability that simply doesn’t afford them the ability to respond.
2. The other major issue we have also encountered is that people have had financially changed circumstances between 2020 and 2023 when the program “restarted.” For example, you’re a Medicaid recipient who is receiving home and community-based services, which have an asset threshold test of only $8,000. Before 2020, your assets were below this amount, but then you inherited $25,000 in 2021. You had no duty to report this money back in 2021. Then, a person receives the notice to verify assets after April 1, 2023, and fails to timely verify that such assets have now been properly reduced or fails to timely file an appeal to fix the situation.
If this occurs, not all hope is lost. While arduous, the Medicaid applicant can reapply for Medicaid once the financial issues are resolved. But, if you file a timely appeal, you can frequently keep your Medicaid benefits throughout the appeal period, even if it takes several months.
In summary, we have another long road to navigate across the commonwealth this year in order to finally get back to a baseline. The important thing to remember is that if you receive any notice from the DHS local county assistance office, you must respond with any information by the notice due date just to keep your case open and benefits flowing while you sort it out.
Julian Gray and Frank Petrich are Certified Elder Law Attorneys with over 65 years of combined elder law experience who practice in the Pittsburgh area at Julian Gray Associates. Send questions for consideration in this column to elderlawguys@grayelderlaw.com and visit their web site at www.grayelderlaw.com.