How to avoid becoming uninsured in Pa. and N.J. with the end of the COVID public health emergency

Close to a million Pennsylvania and New Jersey residents who enrolled in Medicaid during the COVID-19 pandemic could lose the publicly funded health insurance that was a lifeline when they unexpectedly found themselves out of work — and uninsured — while a novel virus drove home the importance of health insurance.

For the last three years, states have suspended rules that require people to annually reapply for Medicaid, the publicly funded health insurance program for low-income families. Beginning in April, Medicaid’s renewal process will resume.

People who signed up for Medicaid more than a year ago will need to renew coverage by proving that they still meet income requirements. Those who are no longer eligible — or fail to complete needed paperwork in time — will lose Medicaid coverage.

The Urban Institute, an economic and social policy think tank in Washington, estimates that 494,000 people in Pennsylvania and 352,000 in New Jersey will lose Medicaid coverage by June 2024, though many are expected to gain coverage elsewhere, according to a December report.

“People are really unsure about what’s happening,” said Laura Waddell, the health care program director at New Jersey Citizen Action, which helps people enroll in health coverage.

Many are new to Medicaid and unfamiliar with the program’s policy of revoking benefits when people don’t re-enroll — a key difference from private employer-based health plans that typically renew automatically. Others may be unaware that they need to take action because the state is trying to reach them at outdated contact information.

An increase in the number of people who are uninsured is “inevitable,” said Patrick Keenan, policy director at Pennsylvania Health Access Network, which helps people sign up for Medicaid and Affordable Care Act marketplace health insurance plans.

“It’s really about making sure that’s for the shortest period of time possible,” he said.

» READ MORE: What does the end of the pandemic public health emergency mean for you

Here’s what to know about Medicaid as the end of the COVID-19 public health emergency ends:

First, it’s important to know that no one’s Medicaid benefits will disappear overnight. Pennsylvania and New Jersey expect to take a full year — at least — to work through the backlog of overdue renewals.

About 30 days before your coverage expires, you’ll receive a renewal packet in the mail. Complete the packet and return it by mail, or follow the included instructions to renew online.

Medicaid will send notices by mail, phone, text, and email to alert people that their renewal deadline is approaching. Agencies are expected to begin reaching out to people at least 90 days before their coverage expires.

Most important, you will be asked to provide proof of your current income.

The number of household members, their ages, and employment statuses are all questions included in the Medicaid renewal questionnaire.

Find out when your plan is due for renewal by calling the Pennsylvania Department of Human Services (866-550-4355) or NJ Family Care (800-701-0710). Pennsylvania residents can use or create an online COMPASS account to check the status of their Medicaid coverage, as well as to apply for other public benefit programs and track the application progress.

Update your contact information, especially if you’re unable to find out when your plan expires. Your current mailing address, email address, and phone number are critical for Medicaid and the program’s community health partners to alert you when it’s time to renew your coverage.

Prepare an accurate income estimate. Medicaid is based on current income. But if your income fluctuates significantly — for instance, you do seasonal work — you may be earning significantly less in a few months than you are now. Keenan suggests making note of this and including an estimate of projected income, even though it is not explicitly requested.

Most people hear whether their renewal application has been approved within 30 days, though Medicaid has up to 45 days to notify people. If you don’t hear from Medicaid within 30 days, Keenan suggests calling to check that there hasn’t been a problem with the application and that the correspondence wasn’t lost in the mail.

You have 90 days to appeal the decision, but don’t wait until the last minute to take action.

Check for errors that could have resulted in income being double-counted — for instance pay stubs from “Toms Pizzeria” and “Tom’s Pizzeria,” Keenan said.

Seek help from a legal aid organization, such as Philadelphia Legal Aid, if you are not confident about appealing on your own.

Most people will keep Medicaid benefits for about a month after they receive a termination notice. It’s important to act quickly to appeal a denial so that you have as much time as possible to enroll in new coverage if you are ultimately unable to remain in Medicaid.

People who lose Medicaid coverage become eligible for a special enrollment period through the Obamacare marketplaces — Pennie in Pennsylvania and Get Covered NJ in New Jersey.

Typically, you have 60 days before and after your Medicaid termination date to enroll in a new marketplace plan.

“Be proactive,” said Jamie O’Brien, director of the navigator exchange program for the Center For Family Services in New Jersey, which contracts with New Jersey to help people “navigate” the insurance enrollment process. “If you’re in a position to know you’re going to be losing coverage, come to us, let us help you.”

The vast majority of people qualify for a tax credit to offset premium costs for marketplace plans. Tax credits vary based on income and ensure that no one pays more than 8.5% of income for a middle-of-the-road plan.

Families and individuals who are just over the income limit for Medicaid eligibility may be able to get a marketplace health plan for free.

In Pennsylvania

In New Jersey