Medicaid Unwinding Nears End
Pennsylvania is on track to complete all renewal activity related to the Medicaid “Unwinding” by June 14th, according to reports by Department of Human Services (DHS) officials. Recall that DHS lifted the pandemic-era continuous coverage protections in April 2023 and chose to conduct its unwinding over the next twelve months. An average of over 300,000 people per month have gone through the Medicaid renewal process in the past year. DHS reports that approximately 60,000 unwinding renewals remain to be completed before its mid-June deadline.
Overall Medicaid enrollment in Pennsylvania has declined by nearly 15% in the past year, from 3.7 million in March 2023 to 3.16 million as of March 2024. Data regarding renewal outcomes stratified by gender, race & ethnicity, county, and age groups can be found on the DHS website here, though this is current only through November 2023.
Recipients whose Medicaid is closed have 30 days to appeal that action and 90 days to request a reconsideration. A new application for Medicaid or CHIP can be filed at any time. Adult recipients who are found to no longer quality for Medicaid, as opposed to being closed because a renewal or related paperwork was not submitted or processed, should be referred to Pennie, the state’s health-insurance exchange, and have 60 days to choose a new insurance plan.
Medicaid officials recently reported that DHS will soon send targeted mailings to approximately 2,000 people whose coverage was stopped during the unwinding. DHS will notify this cohort who had both a disability and earned income that they potentially qualify for Medicaid in the Medical Assistance for Workers with Disabilities (MAWD) category. Medicaid recipients or applicants who are working despite having a disability should be reviewed for MAWD without having to request it, but this requires knowledge of the program and manual action by County Assistance Office caseworkers. The state’s eligibility system requires a change to determine MAWD eligibility in the same manner that it does for other Medicaid categories. More information on MAWD generally can be found in this guide and on combining MAWD and HCBS waiver programs in this guide.
Individuals who need help appealing a Medicaid termination or denial can call PHLP's Helpline at 1-800-274-3258 to apply for free legal services.
