Originally published in The Philadelphia Inquirer on January 14, 2023.
West Philadelphia resident Aisha Ahmad has kept her Medicaid insurance during the pandemic even though she hasn’t sent in her annual renewals.
That’s because a rule from March 2020 prohibited states from ending Medicaid coverage except in a few circumstances, such as a move to another state. That changes in April. People like Ahmad, 60, will have to start reapplying or risk losing coverage.
Just the possibility of losing her Keystone First insurance stresses Ahmad, who works as a contractor with people who have intellectual disabilities. “If you’re living, you need medical,” Ahmad said Saturday.
Ahmad is among hundreds of thousands of Pennsylvanians who have been able to keep Medicaid coverage even if they didn’t reapply annually as is normally required.
Nearly 600,000 Pennsylvanians — including about 90,000 in Philadelphia — have kept Medicaid despite being ineligible the last time they went through the renewal process, state officials said.
Getting the word out
Ahmad spoke while washing clothes at the Laundry Café in the Parkside section of West Philadelphia. That’s one of the sites where Fabric Health, a Philadelphia start-up that does regular outreach for insurance companies, helps people navigate complicated benefits systems and sign up for insurance.
Saturday’s event, where Fabric Health was paying for $10 worth of laundry for customers, was geared toward helping people sign up for health insurance through Pennsylvania’s Affordable Care Act marketplace, which is called Pennie, before the end of this year’s open enrollment at midnight Sunday.
But for Fabric Health cofounder Courtney Bragg the coming change to Medicaid was a priority. She said 40% of the families Fabric Health connects with at laundromats have Medicaid insurance. None she’s talked to know the end of uninterrupted Medicaid coverage is looming.
“I’m just very worried about the tsunami that is coming,” she said.
Statewide, nearly 3 million people were covered by Medicaid in November, up from 2.2 million three years ago, state figures show.
Pennsylvania’s plan as Medicaid changes
The Pennsylvania Department of Human Services, which regulates Medicaid, says no one will lose Medicaid without a chance to reapply — though advocates worry about the state having three-year-old addresses for some people.
Plus, the agency is going to take a year to work through all the people who have not filled out renewal forms during the pandemic. Some states are taking less time, making it more likely that people will fall through the cracks. Pennsylvania’s timeline means that a person who before the pandemic would go through annual renewal in September, for example, won’t have to worry about a big change until April.
Next month, the agency will start sending out 90-day renewal notices, asking Medicaid beneficiaries to let the state know if anything has changed about their circumstances. A month later a 60-day notice will explain what the person needs to do to reapply.
Officials will send those notices by mail, email, and text.
The state will refer people who no longer qualify for Medicaid because their income is too high to Pennie, the state’s Obamacare marketplace. Anyone who loses Medicaid will be able to get a plan on Pennie after open enrollment ends.
Medicaid’s annual income limit for a family of four in Pennsylvania is $36,908 before taxes, according to the federal benefits website.
Much could go wrong, advocates fear
Jamila McLean, senior health-care policy manager at Benefits Data Trust in Philadelphia, a nonprofit that helps people sign up for government benefits, praised state Medicaid officials for laying out in great detail their approach to contacting people about the coming big change.
But still, McLean is worried.
“There’s an entire population of people who have never done a Medicaid recertification,” McLean said. “For them, all they’ve known is, I applied, I got the benefit, and they don’t know this is coming because they’ve probably never done it before.”
“Then there’s another population of folks. They may have done a renewal,” McLean said, “but it’s been three years. If you haven’t done something for three years, it begins to feel extremely hard. To a lot of them this will feel like a new process.”
Keystone First, an Independence Health Group unit that is the largest Medicaid insurer in Southeastern Pennsylvania, hired Benefits Data Trust to reach out to its members who could be at risk of losing coverage.
“We’re trying to limit and decrease as much as possible the number of people who would be disenrolled simply for not completing the process,” said Joanne McFall, market president for Keystone First.