The federal government's pandemic-era prohibition against kicking people off Medicaid is ending, meaning that hundreds of thousands of people in Pennsylvania face losing the free health insurance in the coming year.
Many people who stand to lose Medicaid coverage don't know the changes are coming, say officials at advocacy organizations who do outreach to the poor. That could mean people — parents of school-age children, for instance — find out they have no coverage when they go to fill a prescription or see a doctor for a sick child.
Enforcing the eligibility rules will be a massive task that will test the new administration of Gov. Josh Shapiro, and advocates predict that caseworkers will be flooded by questions from confused enrollees who appeal or reapply when they are denied benefits.
They are worried.
“Very very worried," said Allister Chang, co-founder of Fabric Health, which sets up in laundromats in Philadelphia and Pittsburgh to engage people about public benefits. “Not a single person we’ve talked to so far ... knows that this is coming, including the people who will be affected by this.”
All told, state caseworkers must resume enforcing eligibility rules for more than 3.6 million who are on Medicaid, the federal-state partnership that covers medical care, including primary care and surgeries.
Pennsylvania's Medicaid rolls grew by nearly 30% during the pandemic, when Congress prohibited states from pushing anyone off the rolls. In December, Congress ordered states to begin checking eligibility starting April 1.
Outreach has begun, and the Shapiro administration said about $6 million is budgeted for mass media to urge enrollees to update their contact information and financial information. It will also employ call centers field phone calls and the contact information of enrollees to text, email, call and mail information to them.
Those who are no longer eligible — or who are kicked off because they didn’t submit information — will be guided to the state’s federally subsidized insurance marketplace, named Pennie, where they might find a low-cost plan, or to the Children’s Health Insurance Program, which covers children under low-cost or free plans.
Still, many advocates for the poor predict that an administrative shuffle will victimize people who are eligible.
“We’re just very concerned about the broad implications it’s going to have on people’s access to health care,” said Amy Lowenstein, a lawyer and director of policy for the Philadelphia-based nonprofit Pennsylvania Health Law Project. “It’s not the losing of it, but it’s the losing of it by people who are still eligible and don’t know where to go.”
State officials say 593,000 people who are currently enrolled are no longer eligible — their income has risen above income eligibility limits, for instance. Another 577,000 people currently enrolled haven't submitted financial information recently and the state isn't sure if they're still eligible.
The state will take 12 months to go through the eligibility checks, after it initially said it would carry it out in six months.
The Shapiro administration has thus far said that it will not hire additional workers to handle the casework.
The Harrisburg-based nonprofit Pennsylvania Partnerships for Children wants the Shapiro administration to guarantee that children up to 18 can keep their coverage for another year.
That will protect children from losing health insurance, even if temporarily, while providing peace of mind for parents and lightening the administrative burden on caseworkers, spokesperson Carolyn Myers said.
Many who lose benefits may still be eligible, but don’t realize they have to reapply to renew their benefits — since they haven't had to over the past three years.
Some people may have moved and won't receive a reapplication packet in the mail or see other messages from the state urging them to submit financial information. They'll lose coverage, too, even if they're eligible.
Antoinette Kraus, executive director of the Philadelphia-based nonprofit Pennsylvania Health Access Network, said she worries that they'll give up trying to find coverage if they get kicked off.
“We know a lot of people who do that," Kraus said.
