Pennsylvania is restoring Medicaid benefits for 105,000 people, including many children

Editor’s note: The Pennsylvania Department of Human Services expected to restore Medicaid coverage for 60,000 people, in addition to the 20,000 who had already been reenrolled in the program, as of Nov. 16, 2023. The state corrected its estimate of how many state residents should regain Medicaid coverage, at least temporarily, after the publication of this article.

Pennsylvania is in the process of restoring Medicaid coverage for 105,000 residents who lost their government-funded health insurance benefits this year because they did not return a form on time or for some other procedural reasons.

The coverage terminations happened as Pennsylvania and other states in April resumed checking the eligibility of Medicaid beneficiaries, who qualify based on income level or disability status. The Medicaid review process had been suspended nationwide for three years during the COVID-19 pandemic.

Officials at the Pennsylvania Department of Human Services, which regulates the state’s Medicaid program, said Thursday that it has already restored coverage for 20,000 people and planned to restore benefits for the remainder by the end of this month.

Advocates have been particularly concerned that too many children from low-income families are losing coverage under the method that Pennsylvania and 29 other states use to determine whether people still qualify. Pennsylvania did not say how many children are among the 105,000 who lost benefits.

Pennsylvania was among the states flagged in September by the Centers for Medicare and Medicaid Services over concerns such as the impact of eligibility being determined at the household level. Many children can still qualify for Medicaid coverage, even if the adults in their household do not based on income limits, experts said.

States are supposed to determine whether people are eligible for Medicaid, based on income data the state has access to. They should not require people to fill out forms, Brad Corallo, a senior policy analyst with KFF, a Washington nonprofit that researches health-care policy, said in a September interview.

“As you can automatically renew eligible people, it’s less work for the state. The enrollees don’t have to do paperwork. They aren’t calling into call centers. It just makes things run smoother,” he said.

Pennsylvania and 29 other states look at households, rather than individuals, when processing automatic renewals.

The problem with that method is that people can qualify for Medicaid in different ways, with different income levels for children and adults, Corallo said. There are also distinct rules for people with disabilities.

“Generally, children can qualify for coverage at higher income levels than adults can,” he said.

In Pennsylvania, adults qualify at 138% of the federal poverty level, but kids are still eligible if they are part of a household making up to 319% of the federal poverty level.

In some instances, the state may send households a form seeking more information. If a parent doesn’t return it on time, the whole family would lose coverage, even though the kids should have kept it, Corallo said.

Pennsylvania said it will provide coverage retroactive to the date when the individuals and families lost their insurance.

From April through August, the state terminated coverage for 119,894 people for procedural reasons. Most of those people now have another chance at review.

And another 143,310 lost coverage because they no longer qualify, according to state data.

Before the post-COVID review process started, the state had 3.7 million people enrolled. As of August, Pennsylvania Medicaid enrollment was down to 3.5 million. The latest total could include people who are new to Medicaid.

Nationwide, 10 million people have lost Medicaid coverage through Nov. 8, according to KFF. In March, 95 million Americans were enrolled in Medicaid or the Children’s Health Insurance Program.