Federal Public Health Emergency Renewal Extends Key Medicaid Protections

Earlier this month, the U.S. Department of Health and Human Services again renewed the federal Public Health Emergency (PHE) declaration based on the coronavirus pandemic.   The PHE declaration was set to expire on October 23.  This extends the federal PHE – and important Medicaid protections in place in Pennsylvania based on this authority – until at least January 20, 2021.  

Continuous Coverage  

The Families First Coronavirus Response (Families First) Act requires states to provide continuous coverage for all Medicaid beneficiaries until the end of the month in which the federal PHE declaration ends.  This means that most people on Medicaid must continue to receive Medicaid through January 31, 2021, even if they are no longer eligible.  States can only close a person’s Medicaid coverage at their request or based on certain narrow exceptions to the continuous coverage rule.    

Beneficiaries Turning 21 Retain Benefits Available to Children  

In addition to providing coverage protections, the Families First Act also requires states to maintain beneficiary benefit levels during the federal PHE.  Groups affected by this protection include certain people who become dually-eligible for Medicare and Medicaid when they turn age 65 and young adults who “age out” of the benefit package for children when they turn age 21.  As previously reported, this protection allows young adults to continue receiving the same scope of services they were entitled to before turning 21 – such as private duty shift nursing and Intensive Behavioral Health Services – until at least January 31, 2021.    

Pediatric Shift Nursing “Freeze” 

The extension of the federal PHE also allows Pennsylvania to continue administrative flexibilities like the protections currently in place for pediatric skilled nursing services.  As one of many temporary changes approved through 1135 waiver authority, DHS in early April removed prior authorization requirements for many services and effectively “froze” existing authorizations for in-home pediatric skilled nursing services.  Any shift nursing requests newly approved since April are also covered by these protections.  State officials have confirmed in public meetings that DHS will continue the shift nursing protection for as long as the federal PHE remains in effect.    

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