COVID-19 FAQs

On June 25, 2020, OLTL released its plan to wind down the temporary flexibilities in place during the public health emergency (See “Transition Plan to Phase Out Temporary Changes to the Community HealthChoices 1915(c) Waiver”).  Under this guidance, CHC-MCOs can begin doing needs assessments and reducing Waiver services once the participant’s county enters the green re-opening phase.  As of July 3, As of July 3, all counties are in the green phase of reopening. However, as the COVID-19 response evolves, this new guidance is subject to change. 

A. Person Centered Service Plans (PCSPs)

When a county enters the green phase, the CHC-MCOs may begin conducting comprehensive needs reassessments that were missed due to the public health emergency (PHE) and services can be adjusted based on the outcome of the reassessment. The CHC-MCOs must follow the established comprehensive needs assessment process prior to making any service reductions on the participant’s PCSP. Services on the PCSP that were increased or provided in a modified manner to address COVID-19 are considered temporary increases/changes. This is where further discussion will occur between OLTL and the Consumers as noted above.

B. Service Coordination

When a county enters the green phase, Service Coordinators should monitor participants and PCSPs through face-to-face contacts when possible. Monitoring of participants and PCSPs may be done remotely when risk factors are present in the participant’s home. When a county was in the red phase, this was all being done through telephone or telemedicine.

C. Initial Level of Care Assessments using the FED

When the county enters the green phase, initial level of care assessments using the FED (Functional Eligibility Determination tool) that take place in a participant’s home should be conducted face-to-face when possible. Assessments may be conducted remotely when risk factors are present in the participant’s home. Assessors must follow the guidance issued by the Independent Assessment Entity for resuming face-to-face assessments and maintain safe behavioral practices as defined by the CDC and the Department of Health when doing so (e.g. wearing appropriate PPE.)

Initial level of care assessments using the FED that take place in nursing facilities should be conducted remotely using phone or video conferencing. Assessors should follow guidance around visitation in nursing facilities that is issued by the CDC and the Department of Health.

D. Needs Assessments and Reassessments

Annual Reassessments should be conducted face-to-face when possible, unless risk factors are present in the participant’s home. Annual reassessments that were delayed beyond the 365-day requirement must be completed no later than 6 months after the county has transitioned to green.

Comprehensive Needs Reassessments should be conducted face-to-face when possible, unless risk factors are present in the participant’s home.

E. Personal Protective Equipment (PPE)

Appendix K allowed PPE such as gloves, gowns, and masks for participant to be obtained as Specialized Medical Equipment and Supplies. This flexibility will continue for the duration of the Appendix K approval regardless of the county’s status.

F. Respite

Respite in a licensed facility may be extended beyond 29 consecutive days without prior approval by the CHC-MCO, in order to meet the participant’s health and safety needs. This was the case when counties were in the red or yellow phase.  When a county transitions to green, this flexibility continues if the need for additional Respite is a result of COVID-19. The only change is that now, prior approval by the CHC-MCO is required. This remains in effect for the duration of the Appendix K approval.

G. Personal Assistance Services

When a county enters the green phase, spouses, legal guardians, and persons with power of attorney may no longer serve as paid direct care workers. Participants will be expected to resume using their existing direct care worker or a replacement worker, if necessary. 

Yes. MA and CHIP both cover testing and treatment for COVID-19. 

Coverage of Testing

Both MA and CHIP will cover testing for COVID-19 when your doctor or health care professional determines it necessary. 

There is no co-pay for testing, so consumers pay nothing for the test.  No prior authorization (permission) from your insurer is required to get tested.   

The Pennsylvania Department of Health has released a fact sheet with information about how to get tested for COVID-19.  Testing had been prioritized for people who are severely sick, people in facilities, people in contact with known cases of COVID-19, and health care providers; however, testing kits are becoming more widespread and available.  If you are having symptoms and want to get tested, call your doctor, health insurance company, local health department, or the PA Department of Health at 1-877-PA-HEALTH (1-877-724-2584).  

Coverage of Services to Treat COVID-19 Symptoms

There is no specific antiviral treatment for COVID-19, but MA covers a broad range of services that treat and/or relieve COVID-19 symptoms, including:  

• Imaging (e.g., CT Scans, X-Rays) and Diagnostic Testing;

• Hospital Care (Inpatient & Outpatient);

• Emergency Ambulance Transportation;

• Non-Emergency Transportation to MA Covered Appointments (where telehealth is not an option);

• Home Health Services;

• Nursing Facility Care; 

• Prescription Drugs, including over-the-counter medications for fever relief and other medications related to the treatment of virus symptoms - e.g. counter cough and cold preparations. Over-the-counter medications must be prescribed by your doctor or health care practitioner. To ensure you have a 30-day supply of prescriptions, refills may be covered before the refill date. 
   

The state has temporarily suspended co-payment requiments for MA services related to testing and treatment of COVID-19 (including vaccines, specialized equipment, and therapies like drugs.)  Specifically, MA copayments are suspended for the following drugs/drug categories, as they may be used in the treatment of COVID-19:

• Acetaminophen;
• Antidiarrheals;
• Antiemetics;
• Antihistamines (Second Generation);
• Anti-infectives;
• Asthma/COPD;
• Ophthalmic Antihistamines/Decongestants;
• Ophthalmic Lubricants; and
• Oral NSAIDs 
   

As of March 1, 2020 the Department will pay for prescriptions for cough and cold medications for MA beneficiaries 21 years of age and older. Prior to the public health emergency, the Department was already paying for over-the-counter (OTC) cough and cold medications for MA beneficiaries under 21 years of age.  If you paid a copay for OTC medications between March 1 and April 21 that you believe you should not have paid, you can request a refund from your pharmacy for this payment. 

Additionally, MA benficiaries may not be charged for the use of Personal Protective Equipment (PPE) in connection with a MA-covered medical or dental service.

Testing with Medicare Coverage:  Medicare also covers COVID-19-related laboratory testing when ordered by a physician without any co-insurance or deductible.   The standard Part B deductible ($198 in 2020) applies to other COVID-19-related outpatient Medicare services, besides laboratory tests.  CMS released a fact sheet addressing Medicare Coverage and Payment Related to COVID-19. 

Yes.  Health care providers can submit claims for COVID-19 related treatment for the uninsured to HRSA.  If you think you have COVID-19, do not delay seeking treatment because you fear incurring medical bills!

For more information, visit the the HRSA website,  COVID-19 Claims Reimbursement.

Generally, no! Most Pennsylvanians who had or get MA, CHIP, MA nursing home or Waiver coverage on or after March 18, 2020 cannot lose that coverage until the end of the public health emergency. The ONLY exceptions are cases where the person:

• Voluntarily ends their coverage;
• Is no longer a PA resident;
• Is deceased;
• Received MA because they were found presumptively eligible for the program by a hospital or pregnancy provider, but who are ultimately determined ineligible for MA;
• Is a “lawfully present” immigrant who received MA because they were under 21 and who is not eligible for any other MA category when they turn 21*; or
• Is a “lawfully present” immigrant who received MA because they were pregnant and is not eligible for any other MA category when their 60-day postpartum period ends*
   

As indicated above, PHLP has heard from consumers whose coverage was wrongfully terminated during the crisis. But the state has committed to reopening these individuals' benefits as soon as possible, in accordance with this Policy Clarification released on April 24, 2020.

If you had MA, CHIP, MA nursing home, or Waiver coverage on or after March 18 and your coverage is terminated while the COVID-19 crisis is still going on, call PHLP's Helpline at 1-800-274-3258!

* For information about immigrant eligibility for Medicaid, please see PHLP’s Health Care for Immigrants:  A Manual for Advocates in Pennsylvania.

All County Assistance Offices (CAOs) across the state are closed to the public effective March 17, but are still processing MA applications and requests for other public benefits.  

Even though CAOs are closed to the public, you can still apply and renew MA and CHIP online at www.COMPASS.state.pa.us.  Applicants can download the MyCompassPA app to their Apple and Android devices.   

Applicants can also complete a paper MA application (available here) and either mail the application to the CAO, or dropping it off at the CAO’s secure drop box.  Note that there is no way to obtain a receipt for dropping off application paperwork right now; thus, we recommend submitting applications and other documentation online through COMPASS wherever possible.  

Uninsured individuals with COVID-19 who apply for MA coverage can get a faster decision on their MA application. To do this, mention COVID-19 as the reason for the application in the comment section of the COMPASS application or, on paper applications, in the section asking about medical conditions that affect ability to work.

The state has instructed caseworkers to accept self-attestation for all eligibility criteria (e.g., income) when documentation is not available. The exceptions to this self-attestation rule include: verification of citizenship and immigration status, verification of Emergency Medical Condition for EMA applications, and verification of functional eligibility for Long Term Care (LTC) and Home and Community Based Services (HCBS), aka Waiver.

Changes impacting benefits (e.g., new address, change in household size) can and should still be reported through the Statewide Customer Service Center at 1-877-395-8930.

No. Stimulus payments to households through the CARES Act  do not count as income for Medicaid, CHIP, Medicaid Long Term Care (Nursing Home and Home & Community Based Services Waiver), and other important public health benefits.  As a reminder, under the CARES Act most folks will receive $1,200 per adult ($2,400 for a married couple) and $500 per dependent, including children age 17 or younger.   

Importantly, the fair consideration rules that normally apply when determining eligibility for Medicaid long term care benefits either in a nursing home or home and community-based services will not apply to these payments. These payments will also not impact the patient pay amount for someone on Medicaid in a nursing home.

Note that individuals should still report their receipt of the stimulus money through COMPASS or by calling the Statewide Customer Service Center at 1-877-395-8930, just as they are typically required to do with other changes related to benefits. However, again, the money should not be counted as income or a resource! 

Yes. However, the extra $600 per week that individuals can receive under Federal Pandemic Unemployment Compensation (FPUC) will NOT count for MA or Waiver financial eligibility.  See Operations Memorandum #20-05-02.  Besides FPUC, all other kinds of Unemployment Compensation (UC) counts as unearned income, including regular UC benefits, Pandemic Emergency Unemployment Compensation (PEUC) benefits, and Pandemic Unemployment Assistance (PUA) benefits.

For more information, read our News article, Impact of COVID-19 Financial Assistance to Households on Health Insurance Eligibility, and accompanying Fact Sheet.

In Pennsylvania, no one should be denied MA for COVID-19 testing, diagnosis or treatment because of their immigration status.  COVID-19 is a recognized Emergency Medical Condition, therefore Emergency Medical Assistance (EMA) will be available for coverage of COVID-19 testing, diagnosis, and treatment for those who otherwise qualify for EMA. 

Moreover, using MA for COVID-19 testing, diagnosis and treatment creates no public charge risk.  As has always been the case under the new public charge rule, the very large majority of people who are eligible for MA can receive and use benefits without any public charge risk.  In addition, US Citizen and Immigration Services recently announced that COVID-19 testing, diagnosis and treatment will not be considered during public charge tests, even if MA is used to access these services. 

No. Although Medical Assistance for Workers with Disabilities (MAWD) ordinarily requires individuals to work to receive benefits, people with MAWD coverage should ask to be granted a Good Cause exception to keep their benefits when they are furloughed from employment.  In these circumstances, MAWD coverage will not be canceled based on a lack of employment.  As stated in Operations Memorandum 20-03-03, the CAO will not close any MA benefits during the COVID-19 emergency.

If MAWD was terminated due to non-payment of January or February premiums , the CAO should reinstate MAWD benefits as long as the individual attests that they mailed their January & February premium payments to the MAWD program. See Policy Clarification PMW-19919-316, MAWD Reinstatement for Individuals Who Self-Attest to Paying Premium During the COVID-19 Emergency, May 5, 2020.

MAWD recipients must report to the CAO if they are no longer working, as with any other changes. The CAO will give a Good Cause exception for each month of the COVID-19 emergency.

Good Cause can also be granted to waive MAWD premium payments during the COVID-19 emergency. Ordinarily Good Cause is only available for two months; the COVID-19 emergency has extended that limit.  See Policy Clarification PMW-19831-316, MAWD Premium Payments during the COVID-19 Emergency, March 26, 2020.

In many cases, yes. Medical Assistance (MA) MCOs are making sure their provider networks can handle an increase in health care services related to COVID-19.  If an MA MCO does not have enough health care providers in its network with the appropriate training and experience to meet the needs of its members, the MCO must cover services by providers who are out-of-network. Consumers should call their MCO’s Member Services line (listed below) with any difficulty obtaining services.  Consumers in the MA Fee-for-Service Program should call the Recipient Service Center at 1-800-537-8862 if they are having difficulty obtaining services. 

Limiting Non-Essential Elective Services
In accordance with previous Department of Health and CMS recommendations, DHS initially released guidance directing MA insurers to restrict non-essential elective surgery and medical procedures, including dental, until after the public health emergency subsides. However, that guidance was rescinded on May 7, 2020. See Provider Quick Tips: Rescinding Prior Guidance On Elective Services and Managed Care Operations Memo 05-2020-12: Elective Services.

Expanded Use of Telehealth
Because COVID-19 is a communicable disease, you may prefer to receive health care services using telehealth instead of in-person. Telehealth is two-way, real time interactive communication between you and your doctor or other provider.  

The state has strongly encouraged the use of telehealth visits for all MA consumers in Fee-for-Service and MCOs.  Additionally, all MCOs offer a 24/7 nurse phone line available for consumers to consult with various health-related questions. The Office of Long-Term Living has also encouraged providers to use telehealth and telemedicine broadly, including for assessments which otherwise take place in-person at an individual’s home.   

The Office of Mental Health and Substance Abuse services (OMHSAS) has issued guidance expanded existing mental and behavioral telehealth services to include treatment provided by a number of providers including:

• Certified Registered Nurse Practitioners (CRNPs);
• Physician Assistants (PAs) certified in mental health;
• Licensed Clinical Social Workers (LCSWs);
• Licensed Professional Counselors (LPCs); and
• Licensed Marriage and Family Therapists (LMFTs).  
   

Previously, only Psychiatrists and licensed Psychologists could provide behavioral health via  telehealth services.  Additionally, individuals may now use telehealth directly with their providers by way of smart phones and other electronic devices. 

The state continues to process applications for MA funded long-term care for older adults and individuals with disabilities served through providers licensed by the Office of Long-Term Living, including personal care homes and in-home care.  The Independent Enrollment Broker (IEB) is still processing applications.  To apply for waiver services, call the PA Independent Enrollment Broker (PA IEB) at 1-877-550-4227.  It has been reported to PHLP that functional eligibility determinations (FED) which assess whether applicants meet the clinical standards to qualify for in-home services, may be conducted remotely using phone or video conferencing; the face-to-face requirement has been temporarily waived.   

The Office of Long Term Living (OLTL) is suspending long-term care clinical eligibility redeterminations during the COVID-19 emergency. The Office of Developmental Programs (ODP) has extended eligibility redeterminations to 18 months, so participants in ODP’s programs will also not lose services during this period. 

Children under age 21 with authorizations for shift nursing on or after April 9, 2020 can continue to receive their authorized skilled nursing hours without the need for reauthorization.  See Provider Quick Tip #241: Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID-19 Emergency Disaster.

If your child's doctor requests an increase in hours beyond what is currently authorized as of April 9, 2020, or if your child's doctor is requesting nursing hours for the first time, the request will require the typical prior authorization process. Once the increase in services are authorized, the authorized hours of care will continue without need for reauthorization for the duration of the crisis.

The Medical Assistance Transportation Program (MATP) continues to operate in every county in Pennsylvania. However, during the COVID-19 emergency, consumers should be prepared for more limited availability of transportation services, and should be prepared to wear PPE like face masks during any MATP rides. To read our fact sheet on MATP during COVID-19, click here.

DHS has released guidance on use of MATP during the COVID-19 crisis; indicating that telehealth should be used instead of in-person visits where possible, and that only certain types of face-to-face visits should be prioritized by MATP providers. These visits include dialysis, chemotherapy, radiation, IV therapies that cannot be done at home, high-risk pregnancy care, urgent clinical visits, trips to the pharmacy, and medication assisted treatment (methadone, buprenorphine, and naltrexone).

This guidance also explains that MATP will use screening criteria for drivers and consumers that may make transportation through MATP unavailable or inappropriate for consumers with compromised immune systems or who are otherwise at risk of contracting or communicating COVID-19. Consumers will be asked screening questions about COVID-19 exposure and symptoms, before MATP will schedule their ride.

DHS has also issued guidance reminding providers that nonemergency ambulance transportation may be used when medically necessary to transport consumers to medical appointments when transportation through MATP is not available or appropriate according to the COVID-19 screening criteria.

Additionally, DHS increased the mileage reimbursement rate temporarily for the duration of the emergency, from $.12 cents per mile to $.25 cents per mile. 

To arrange for transportation using MATP, call your local county MATP provider. 

Yes. In fact, your access to prescriptions should improve.  The state notified MA MCOs that they must allow their members to obtain early refills of all prescriptions at the pharmacy during the COVID-19 emergency period.  This includes early refills for opioids for pain management and medication-assisted treatment for opioid use disorder.  The prior authorization requirement based on day supply for short-acting opioids remains in effect.  MCOs can authorize prescriptions for longer than normal durations when medically necessary during the COVID-19 pandemic.  

Yes! 

You can file a Grievance if your Managed Care Organization reduces, denies, or terminates your services. But remember: CHC-MCOs may not reduce or terminate any existing Waiver services -- e.g. personal assistance services -- during the crisis!

The Bureau of Hearings and Appeals (BHA) is open and holding all hearings by telephone; even if an in-person hearing is requeasted. Additionally, if you had a hearing scheduled during the two-week BHA closure in March, your hering should be rescheduled shortly and you'll be notified of the new date and time.

The CAO will accept MA appeals filed within 90 days from the date on the denial or termination notice. Usually, the deadline is much shorter-- just 30 days. But remember, anyone who had MA, CHIP, or Waiver coverage as of March 18, 2020 or later should not lose their coverage during the crisis! 

Ordinarily, you have 15 days to appeal a CAO denial or reduction of MA in order to keep your MA active while the appeal is going on. But during COVID-19, the CAO will continue MA benefits if you appeal after 15 days of the notice mail date, and you request that your MA benefits be reinstated until BHA makes a hearing decision.

Yes. You can change your CHC Plan by calling the Independent Enrollment Broker at 1-844-824-3655 (TTY: 1-833-254-0690). You can change your Physical HealthChoices plan by calling PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225).

There was a brief period in May and June 2020 when CHC plan changes were not allowed. However, that freeze on CHC plan transfers is over. CHC participants who requested plan transfers during the freeze are supposed to be contacted by the Independent Enrollment Broker to confirm they still wish to switch plans. You may also reach out to the Independent Enrollment Broker to confirm you still want to switch plans.