Medicaid Appeal and Renewal Process Plagued By Problems as Cutoffs Loom for 1.2 Million PA Residents
Late Redetermination Letters, Confusing Eligibility Requirements, and Website Issues Cause Concern
Pennsylvania— Since the bipartisan decision by Congress to end the continuous coverage requirement for Medicaid on April 1st , Put People First! PA has collected numerous reports of errors and inconsistencies in the appeal and renewal process from residents across Pennsylvania who are in danger of having their benefits revoked.
With the continuous coverage deadline’s expiration, over 15 million people in the U.S. are facing the prospect of becoming uninsured or being forced to purchase private health insurance plans with high copays and deductibles, including 1 million Pennsylvania residents who must navigate a complex and time-consuming eligibility process that is marred by bureaucratic issues.
Everyone who gets a “redetermination letter” from the Department of Human Services has the right to file an appeal – Put People First! PA is organizing to ensure that people are informed and able to exercise that right.
One disabled PA resident reached out to Put People First! PA after receiving a letter stating he would lose his Medicaid coverage based on financial ineligibility, as the eligibility requirements include money saved for retirement but do not subtract personal debt or medical expenses. The resident suffers from stage 3 kidney disease and would be unable to afford treatment with his current income, which is only slightly above the cut-off. When the resident received their redetermination letter, they had only 1 day left to complete an appeal.
A person on Medicaid has only 15 days from the day the letter is sent – not received – to file an appeal and keep their healthcare; if they receive their cutoff letter after 15 days, they lose their Medicaid coverage. If they appeal, it could take months to get their healthcare back.
“This just seems like a very unfair process,” said Tammy Rojas, resident of Lancaster and member of Put People First! PA. “Many poor people on Medicaid are receiving redetermination letters they have difficulty understanding, and are being given much less time to respond than they were promised. We know DHS is understaffed, but we reject these cutoffs for putting many vulnerable PA residents in an impossible situation.”
PA residents and members who are filing for renewal of their benefits have encountered similar problems. PA Director of Human Services Valerie Arkoosh claims that residents will receive their renewal packets 30 days prior to the renewal date, however one member of Put People First! PA reports receiving their packet on April 13th with a postmark date of April 7th – and a renewal date of April 30th. Then, when they went to the website to renew, the website was inoperable.
Put People First! PA estimates these bureaucratic hurdles will prevent many thousands of eligible residents from renewing or successfully appealing to maintain their Medicaid coverage during a historic cost-of-living crisis.
That is why Put People First! PA is demanding that no one lose their healthcare; that PA should instead expand Medicaid to cover all PA residents, fully restore the Medicaid Adult Dental Benefit that was cut in 2011, and that the legislature should pass a law to establish an office of the Public Healthcare Advocate  for Pennsylvania to provide support for residents struggling with healthcare bureaucracy.
For more information on the Public Healthcare Advocate (2021-2022 House Session HB1828), see the policy report released by Put People First! PA in August 2021. https://www.putpeoplefirstpa.org/wp-content/uploads/2021/09/Final-PHA-report.pdf