Medicaid’s redefinition begins in April as the special rule for COVID-19 expires

West Philadelphia resident Ayesha Ahmed kept her Medicaid insurance during the pandemic even though she didn’t send in her annual renewals.

That’s because a rule from March 2020 prohibits states from ending Medicaid coverage except in a few cases, such as moving to another state. That changes in April. People like Ahmed, 60, will have to start re-applying or risk losing coverage.

Just the prospect of losing her Keystone First insurance confirms Ahmed, who works as a contractor with people with intellectual disabilities. “If you’re surviving, you need to be treated,” Ahmed said on Saturday.

Ahmed is among the hundreds of thousands of Pennsylvanians who have been able to maintain Medicaid coverage even if they don’t reapply annually as is normally required.

State officials said nearly 600,000 Pennsylvanians — including about 90,000 in Philadelphia — kept Medicaid despite being ineligible the last time they went through the renewal process.

Spread the word

Ahmed spoke while doing laundry at the Laundry Café in the Parkside section of West Philadelphia. This is one of the sites where Fabric Health, a Philadelphia startup that makes regular outreach to insurance companies, is helping people navigate complex benefit systems and insurance underwriting.

Saturday’s event, where Fabric Health was paying out $10 worth of laundry to customers, was geared toward helping people sign up for health insurance through the Pennsylvania Affordable Care Act market, nicknamed Pennie by Pennie. This year’s open enrollment ends at midnight Sunday.

But for Fabric Health co-founder Courtney Bragg, the upcoming Medicaid change was a priority. She said 40% of the families Fabric Health contacts at laundromats have Medicaid insurance. Nothing I talked about to know the end of uninterrupted Medicaid coverage was in sight.

“I am very worried about the next tsunami,” she said.

at the state level, Almost 3 million people Medicaid was covered in November, up from 2.2 million three years ago, according to state numbers.

Pennsylvania’s plan changes as Medicaid changes

The Pennsylvania Department of Human Services, which regulates Medicaid, says no one will lose Medicaid without a chance to reapply — though advocates worry that some people have titles as young as three years old.

In addition, the agency will take a year to work through all the people who didn’t fill out renewal forms during the pandemic. Some states take less time, making it more likely that people will fall through the cracks. Penn State’s schedule means that someone who was pre-pandemic going for annual renewal in September, for example, wouldn’t have to worry about a major change until April.

Department of Human Services Recommends to anyone with Medicaid insurance To ensure that the state has the individual’s current address by continuing compassState Medicaid website.

Next month, the agency will begin sending out 90-day renewal notices, requiring Medicaid beneficiaries to notify the state if anything changes about their circumstances. After a month, a 60-day notice will explain what the person must do to reapply.

Administrators will send these notices by post, email, and text.

The state will refer people who no longer qualify for Medicaid because their income is too high to Pennie, the state’s Obamacare marketplace. Anyone missing out on Medicaid will be able to get a plan from Pennie after open enrollment ends.

The Medicaid annual income limit for a family of four in Pennsylvania is $36,908 before taxes, according to the Federal Benefits website. In addition, the beneficiary must be pregnant, responsible for a child age 17 or younger, or have a disability or a family member with a disability.

Advocates fear a lot could go wrong

Jamila McClain, senior director of health care policy at the NHS Trust Trust in interest data philadelphiaInc., a nonprofit that helps people sign up for government benefits, commended state Medicaid officials for laying out in great detail their approach to contacting people about the upcoming big change.

But McClane is still worried.

“There’s a whole group of people who’ve never done Medicaid rehab,” McClain said. “For them, all they know is I applied, got the interest, and they don’t know this is coming because they probably haven’t done it before.”

Then there is another group of people. Maclean said, “They may have done a renovation, but it’s been three years. If you haven’t done anything for three years, it starts to feel very hard. To a lot of them this will feel like a new process.”

Keystone First, a unit of the Independence Health Group that is the largest Medicaid insurer in southeastern Pennsylvania, has hired Benefits Data Trust to reach out to its members who may be at risk of losing coverage.

“We’re trying to limit and reduce the number of people who will be deregistered as much as possible simply because they don’t complete the process,” said Joanne McFall, head of market for Keystone First.

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