An independent news publication of
United Way of Lancaster County


In April, Pennsylvania restarted annual reviews of Medicaid eligibility. How’s it going?

Acting Human Services Secretary Dr. Val Arkoosh speaks about Medicare renewals at SACA’s Centro Hispano in southeast Lancaster on Thursday, April 28, 2023. (Photo: Tim Stuhldreher)

Pennsylvania removed nearly 140,000 individuals from its Medicaid rolls in the first four months of its year-long Medicaid renewal and reenrollment process.

That figure includes 5,587 individuals in Lancaster County, according to data published by the state Department of Human Services.

The number of disenrollments is expected to grow as the renewal process continues. About 3.6 million people are enrolled in Medicaid, and the state must redetermine eligibility for all of them.

The same process is playing out in all 50 U.S. states. During the pandemic, the federal government expanded Medicaid eligibility and implemented “continuous coverage,” requiring states to keep people insured without further review once they were enrolled.

Those provisions have now lapsed. States must once again determine eligibility for Medicaid participants annually under standard criteria. Besides Medicaid, the process extends to CHIP, the Children’s Health Insurance Program.

Health advocates have warned that millions of people could lose coverage, including many eligible individuals who are unaware of the re-enrollment requirement or are unable to submit the necessary paperwork.

The grassroots group Put People First PA has called on Pennsylvania to suspend its review and the resulting disenrollments, describing it as a “broken process.”

Indeed, some states have been very aggressive in their Medicaid “unwinding.” Texas ended coverage for slightly under 560,000 people through the end of July, according to state data provided to the federal government and analyzed by the research organization KFF. Four out of five of Texas’ terminations were for procedural reasons, not because individuals were ruled ineligible.

Nationwide, at least 3.8 million people in 38 states have been disenrolled, the Washington Post reported late last month. It noted the Department of Health & Human Services directive that people should not lose coverage “solely due to administrative processes,” but that health advocates say the department has not yet matched that policy statement with a sufficient enforcement push.

Pennsylvania’s data

How does Pennsylvania stack up? According to DHS data, it reviewed 419,105 Medicaid accounts through the end of July and disenrolled 137,525, or just under 40%.

Of those disenrollments, 44% were for procedural reasons, rather than a determination of ineligibility. Among the 40 states with comparable data, that percentage is the fifth lowest, according to KFF. Nationwide, the ratio of procedural terminations to ineligibility determinations is around 75%/25%.

Moreover, according to the Pennsylvania Health Law Project, most of Pennsylvania’s procedural terminations are likely people who were covered under the pandemic’s expanded criteria but are now no longer eligible.

“[I]t does appear that the overwhelming majority of “procedural terminations” — terminations because a renewal or other required documentation was not received by DHS — are among the COVID maintained population,” the organization wrote at the end of June. “This likely includes people who moved but haven’t updated their address with DHS and people who know they are no longer Medicaid eligible so did not return their renewal.”

In Lancaster County, of the 5,587 individuals disenrolled through July, 2,772 were ruled ineligible while 2,815 were terminated for procedural reasons, a split of almost exactly 50-50.

In April, when reenrollment was getting under way, DHS Secretary Val Arkoosh visited Lancaster and pledged that her department would do all it could to maintain health coverage for individuals caught up in the process.

Asked about the data so far, DHS spokesman Brandon Cwalina reiterated that message.

“DHS’ goal throughout the Medicaid renewal process has been to ensure that Pennsylvanians remain covered, whether through Medicaid, CHIP, or other affordable healthcare,” he said.

State Rep. Ismail Smith-Wade-El, D-Lancaster, is a member of the House Human Services Committee and joined Secretary Arkoosh at her April appearance in Lancaster.

“DHS has really done a full-court press” to limit disenrollments and preserve individuals’ coverage one way or another, he said.

Pennsylvania’s reenrollment process will continue a full year, into next March. DHS has posted extensive information about it on its website and encourages people to manage their accounts through the Compass portal. Individuals who need further assistance can call the department, a county assistance office or their state representative’s office.

Individuals who lose Medicaid coverage have up to 90 days to appeal if they believe they have been wrongfully terminated. If they file within 15 days, they are eligible to maintain coverage during the appeal process.

For individuals ruled ineligible for Medicaid, DHS is trying to find other options, including enrollment in Pennie, Pennsylvania’s subsidized individual health insurance marketplace. To date, more than 10,000 former Medicaid recipients have enrolled in Pennie, Cwalina said. The number includes more than 100 from Lancaster County.