OBJECTIVE: This article provides an overview of the reinstatement of the annual Medicaid Renewal (Redetermination) Process that is being reinstated following the end of the federal government's COVID Public Health Emergency declaration. This article is applicable to Pennsylvania Clients who receive Medicaid coverage for their Help at Home services.
Table of Contents:
Frequently Asked Questions
Why does my Client need to renew their Medicaid coverage?
Due to the COVID-19 pandemic, the annual Medicaid verification or redetermination process was paused to ensure Clients were receiving continuous health and long-term care coverage. This means the Client was allowed to continue with Medicaid access even if their eligibility for Medicaid changed. Now that the Public Health Emergency is over, Clients who require Medicaid access will begin receiving communications from the government to ensure they continue to meet eligibility requirements.
When does my Client need to renew their Medicaid coverage?
As prior to the Public Health Emergency, any Client who requires Medicaid coverage will need to respond to the outreach from the Medicaid program when their annual redetermination date arises. The exact date varies per state; Clients may begin receiving communications as soon as April 1, 2023.
| First Month Unwinding-Related Renewals are Initiated | Effective Date of First Anticipated Terminations for Procedural Reasons* |
| March 2023 | May 2023 |
* This is generally the first month that members who have not had their eligibility successfully renewed in the past 12 months may be disenrolled for procedural reasons, such as non-response to a renewal form, per CMS guidelines. Terminations for individuals the state has redetermined as ineligible for Medicaid and CHIP may occur on or after April 1, 2023.
What are the qualifications for Medicaid coverage?
Refer to the following resource for coverage criteria: Pennsylvania Services (pa.gov).
Redetermination Process
1. Update address & contact information
If your Client moved during the pandemic and did not update their address with the state's Medicaid department, then they will need to contact them to make sure the correct address is filed ASAP to avoid any unnecessary coverage disruptions.
NOTE: If the Client's address or contact information has not changed since March 18, 2020, then they do not need to update their information with the state.
Pennsylvania Medicaid Contact Information
- Customer Service Center: 1-877-395-8930
- Phone: 215-560-7226
- Website: COMPASS HHS Home (state.pa.us)
2. Check mail for renewal letter
If previously enrolled in Medicaid (as of March 18, 2020), the Client will receive a letter in the mail about their coverage. This letter will inform the Client to complete a renewal form to see if they still qualify for Medicaid.
3. Complete the renewal form (if applicable).
The Client should complete the renewal form and return it to the state right away to avoid any gaps in coverage.
Communication Tips and Templates
Print and post the attached flyer in your Help at Home branch. See attachment: Stay Covered Flyer PA.
Use the following resources to inform your branches about the Medicaid renewal process:
Source: connectingtocoverage.org; Pennsylvania Department of Human Services