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As Pennsylvania’s Medicaid ‘unwinding’ hits a year, thousands have lost coverage but many haven’t

  • Kate Giammarise/WESA

 Katie Blackley / 90.5 WESA

It’s been one year since Pennsylvania began “unwinding” its pandemic-era Medical Assistance program.

During the pandemic, people could stay enrolled in Medicaid — which provides health insurance to people with disabilities and those with low incomes — without having to complete annual re-enrollment paperwork. That policy has ended — along with other COVID-related aid programs — and for the last year, Pennsylvania’s Department of Human Services has been working to redetermine the status of the more than 3 million Pennsylvanians enrolled in the program.

State officials said they’re pleased with their progress and expect the so-called Medicaid “unwinding” to be largely completed by June.

“We’re really proud of the work that we have been doing here at the Department of Human Services over the last year,” DHS Secretary Val Arkoosh said in an interview last week.

So far, about 1.8 million people statewide have had their coverage renewed, and about 738,600 Pennsylvanians have lost Medicaid coverage, according to state data compiled by health policy and news organization KFF.

“I think the [Department of Human Services], the state’s doing the best they can with what they have, the resources they have available. It’s just been very difficult. It’s difficult all around… the demand far outweighs the personnel available. It’s also very difficult on the side of the participants and the individuals receiving the benefits,” said Bobby Karlavage, an attorney at Neighborhood Legal Services in Pittsburgh who specializes in public benefit cases and who has seen a spike in demand for help with Medicaid-related cases.

Those losing coverage fall into two main categories: people no longer eligible for the program, most likely because their income is now too high, and people losing coverage for paperwork reasons — about 52% of those who have lost their Medicaid, also known as Medical Assistance.

“I think a lot of people did not know they had to renew and were therefore terminated. And now [they] don’t know where to turn,” said Joanna Rosenhein, consumer engagement manager at advocacy group Pennsylvania Health Access Network (PHAN).

DHS Secretary Arkoosh said the agency attempts to contact an individual 11 times through various means, including mail, email, phone calls, and text messages before terminating coverage, as well as outreach through advertising and community events.

One person impacted by these changes is Jen Cox, of Philadelphia.

A full-time substitute teacher, Cox had been on Medicaid but was told earlier this year she was being cut from the program because her income is too high. She said, though, this doesn’t take into account fluctuations in her income — for instance, when she doesn’t get paid over the summer. She’s hopeful she will be able to maintain her Medicaid coverage through an appeal.

She’s being aided in her appeal by advocacy group Put People First! PA, which has been critical of the Medicaid cuts.

“We believe that health care is a human right and that none of us should have to fight like this just to get the health care that we need to stay alive and healthy and take care of our families,” Cox said.

Before being on Medicaid, Cox had insurance through the Obamacare marketplace but said that plan included too many surprise out-of-pocket expenses for her.

“Everyone talks about how that’s so good and that’s such a solution. But, you know, I had a really hard time with that,” Cox said.

About 75,000 Pennsylvanians who have lost Medicaid coverage have been able to get other insurance through Pennie, Pennsylvania’s health insurance marketplace, Arkoosh said.

“These are all Affordable Care Act-compliant plans, and they are often able to get these plans for premiums that are $5 a month, $10 a month, you know, very affordable for them and their families,” Arkoosh said. “So, we want to encourage folks to make sure — if they are currently uninsured — that they are not eligible for Medicaid. And if they’re not, we are eager to make sure that they have easy access to Pennie.”

Gov. Josh Shapiro’s 2024-2025 budget proposes an additional $50 million investment to help lower premiums and assist people purchase insurance on Pennie.

Rosenhein, of advocacy group PHAN, said some people did successfully transition to getting coverage through Pennie, but that hasn’t been the case for everyone.

“We also saw folks who just said it was way too expensive, even with the extra savings that are now available through Pennie, for some people, it’s still just too expensive. And they make a choice to go without coverage,” Rosenhein said.

Some people cut off from Medical Assistance also likely gained employer-sponsored coverage, though there’s no data available on how many people did, she said.

Advocates like Rosenhein said the more relaxed-pandemic era rules and subsequent “unwinding” offer a chance to make Medicaid systems work better, such as by increasing so-called “ex parte” renewals, when the state uses information it already has access to, like income data to renew people’s benefits automatically.

“I think that there’s a lot that can be done to ensure that folks don’t have gaps in coverage and are able to navigate the system a lot more easily,” Rosenhein said.

Arkoosh said some IT upgrades later this year will allow for the agency to do more of those kinds of renewals.

“This never ends for us. This is an ongoing process, and we are really eager to understand how we can continue to improve it,” Arkoosh said.

For more information on Medicaid changes and to check your renewal date or submit your information online, go to the DHS website

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