Unwinding, Unwinding, Unwinding in Pennsylvania

As the Pennsylvania Department of Human Services (DHS) begins the Medicaid Continuous Coverage unwinding April 1, DHS is working in conjunction with PA’s health insurance exchange, Pennie, to minimize the number of people who may become uninsured or fall into the coverage gap. There has been an increase of over 820,000 Medicaid enrollments since March 2020 to over 3.6 million due in part to the continuous coverage provision. Some things to keep in mind as Medicaid redeterminations begin:

  •  The number of recipients churning on and off Medicaid decreased as those likely ineligible for Medicaid remained on the rolls. When “normal” renewal and redetermination processing begins, consumers who are deemed ineligible and have coverage terminated will need to appeal and/or request a redetermination within 90 days. Consumers who have coverage terminated will keep coverage under their current Medicaid managed care organization (MCO) until the end of the month.
  •  Health centers should collaborate with MCOs on outreach to assist consumers with renewals and assistance with enrolling in Pennie, if deemed eligible. Health centers must also rely on health insurance enrollment assisters, eligibility and financial counselors and front desk staff to ensure processes and procedures are in place to identify and remind Medicaid patients to update their demographic information with DHS and their HealthChoices MCO. Consumers can renew over the phone at 1-866-550-4355, complete their renewal online in COMPASS, by mail, or in-person at the county assistance office.

On January 5, 2023, the Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin that included timelines for states to submit a renewal redistribution plansystem readiness plans and results, and baseline unwinding data based on when states plan to begin renewals. Along with enhanced reporting requirements, states are required to report the total number of individuals renewed and those renewed on an ex parte basis, break out Medicaid terminations for children’s coverage and pregnancy-related coverage, report the number of individuals whose coverage was terminated for procedural reasons, and report total call center volume, average wait time, and average abandonment rate. Pennsylvania’s lowest uninsured rate was 5.5% but this number is expected to increase over the next 12 months.