The Daily Press

Resuming Medicaid case checks confronts 3.6M in Pennsylvan­ia

- By Marc Levy

HARRISBURG (AP) — The federal government's pandemic-era prohibitio­n against kicking people off Medicaid is ending, meaning that hundreds of thousands of people in Pennsylvan­ia face losing the free health insurance in the coming year.

Many people who stand to lose Medicaid coverage don't know the changes are coming, say officials at advocacy organizati­ons who do outreach to the poor. That could mean people — parents of school-age children, for instance — find out they have no coverage when they go to fill a prescripti­on or see a doctor for a sick child.

Enforcing the eligibilit­y rules will be a massive task that will test the new administra­tion of Gov. Josh Shapiro, and advocates predict that caseworker­s will be flooded by questions from confused enrollees who appeal or reapply when they are denied benefits.

They are worried. “Very very worried," said Allister Chang, co-founder of Fabric Health, which sets up in laundromat­s in Philadelph­ia and Pittsburgh to engage people about public benefits. “Not a single person we've talked to so far ... knows that this is coming, including the people who will be affected by this.”

All told, state caseworker­s must resume enforcing eligibilit­y rules for more than 3.6 million who are on Medicaid, the federalsta­te partnershi­p that covers medical care, including primary care and surgeries.

Pennsylvan­ia's Medicaid rolls grew by nearly 30% during the pandemic, when Congress prohibited states from pushing anyone off the rolls. In December, Congress ordered states to begin checking eligibilit­y starting April 1.

Outreach has begun, and the Shapiro administra­tion said about $6 million is budgeted for mass media to urge enrollees to update their contact informatio­n and financial informatio­n. It will also employ call centers field phone calls and the contact informatio­n of enrollees to text, email, call and mail informatio­n to them.

Those who are no longer eligible — or who are kicked off because they didn't submit informatio­n — will be guided to the state's federally subsidized insurance marketplac­e, named Pennie, where they might find a low-cost plan, or to the Children's Health Insurance Program, which covers children under low-cost or free plans.

Still, many advocates for the poor predict that an administra­tive shuffle will victimize people who are eligible.

“We're just very concerned about the broad implicatio­ns it's going to have on people's access to health care,” said Amy Lowenstein, a lawyer and director of policy for the Philadelph­ia-based nonprofit Pennsylvan­ia Health Law Project. “It's not the losing of it, but it's the losing of it by people who are still eligible and don't know where to go.”

State officials say 593,000 people who are currently enrolled are no longer eligible — their income has risen above income eligibilit­y limits, for instance. Another 577,000 people currently enrolled haven't submitted financial informatio­n recently and the state isn't sure if they're still eligible.

The state will take 12 months to go through the eligibilit­y checks, after it initially said it would carry it out in six months.

The Shapiro administra­tion has thus far said that it will not hire additional workers to handle the casework.

The Harrisburg­based nonprofit Pennsylvan­ia Partnershi­ps for Children wants the Shapiro administra­tion to guarantee that children up to 18 can keep their coverage for another year.

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, spokespers­on Carolyn Myers said.

Many who lose benefits may still be eligible, but don't realize they have to reapply to renew their benefits — since they haven't had to over the past three years.

Some people may have moved and won't receive a reapplicat­ion packet in the mail or see other messages from the state urging them to submit financial informatio­n. They'll lose coverage, too, even if they're eligible.

Antoinette Kraus, executive director of the Philadelph­iabased nonprofit Pennsylvan­ia Health Access Network, said she worries that they'll give up trying to find coverage if they get kicked off.

“We know a lot of people who do that," Kraus said.

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