Hundreds of thousands in Philadelphia region have to reapply for Medicaid. Here’s an early look at how many could be losing coverage.
State officials said it is too early to draw any conclusions, but advocates are worried.
In April, for the first time since March 2020, people who have health insurance through Medicaid had to start reapplying to see whether they were still eligible.
New data from the Pennsylvania Department of Human Services, which runs the state’s Medicaid program, show that 43,546, or 32%, of the 137,611 Pennsylvanians who completed the process in the first month, were slated to lose Medicaid, declared ineligible because their income was too high or due to a procedural problem, such as not returning documentation.
“It’s scary,” advocate Courtney Bragg said in an interview Saturday, citing an estimate by the Kaiser Family Foundation, a not-for-profit health-care research group, that half the people expected to lose Medicaid are actually still eligible.
“It’s a confusing and multistep process to stay insured,” said Bragg, cofounder of Fabric Health, a Philadelphia start-up that does regular outreach for insurance companies, helping people navigate complicated benefits systems and sign up for insurance.
It’s not clear how many of the 43,546 people who received cancellation notices after the April review ultimately will lose coverage, Acting DHS Secretary Valerie A. Arkoosh cautioned Wednesday at a board meeting of Pennie, the state’s health insurance exchange.
“We’re way too early in the process to say how many have lost Medicaid because of the appeals process,” she said.
People have 90 days to appeal an adverse decision.
A major post-pandemic change
A rule from March 2020 prohibited states from ending Medicaid coverage except in a few circumstances, such as a move to another state. In Pennsylvania, 1.3 million were kept on Medicaid under that rule.
Pennsylvania’s Medicaid enrollment swelled to 3.7 million before the so-called unwinding started.
But in April, the federal government required state Medicaid programs to start terminating coverage for people who no longer qualify. Pennsylvania is not reviewing everyone at once. Instead, the state will ask the individuals to reapply in their usual renewal month.
Part of DHS’ plan was to automatically hand off people who are no longer eligible for Medicaid to Pennie. Pennie said last week that 33,346 of such individuals had applied for coverage and that 3,178 had signed up for a plan.
That number is expected to grow. Under a special enrollment period for Medicaid redetermination, people have 60 days to enroll while maintaining continuous coverage. The full special enrollment period runs 120 days.
A Pennie spokesperson said Saturday that half the Medicaid households transferred to Pennie for insurance signed up for plans with premiums of less than $50 a month. A fifth of those households are paying less than a dollar a month, the spokesperson said.