Pennsylvania cuts at least 137,000 people from its Medicaid program as some participants fight paperwork denials

At least 137,000 people have been terminated from Pennsylvania’s Medicaid program since April, when a pandemic-era rule that had guaranteed continuous enrollment in the low-income health insurance program ended.

Some no longer qualify for the program based on their income, others have failed to submit the yearly renewal paperwork that is again required.

Public health experts say they expect the number of terminations to grow over the next eight months as the state reevaluates roughly 3.6 million people for program eligibility.

Meanwhile, attorneys and legal aid organizations say they’re busy filing appeals on behalf of people who are still eligible for Medicaid, but have been cut from the program because of paperwork issues.

Maripat Pileggi, a supervising attorney at Community Legal Services in Philadelphia, said those people are already feeling the impact of these procedural terminations.

“The calls that we’re getting are for folks who really rely on Medicaid and need it,” she said. “You go to pick up your prescription and you can’t get it. Young people get sick and they end up in the hospital without health insurance coverage and now they have a big bill that they have to deal with. It’s very problematic.”

For some people, this is the first time they will go through the renewal process, which requires enrollees to submit income information and other documentation to county and state officials in order to stay on the program.

The renewal process was paused for nearly three years during the national COVID-19 public health emergency, which ended this past spring.

Missing documents, postal delays, and general confusion about the process and deadlines are the most common factors that lead to procedural terminations, Pileggi said.

Out of all Pennsylvania’s publicly reported termination cases, about 44% are considered procedural. The other 56% of cases involve people who are no longer eligible, either because they’ve moved to a different state or their income is higher than the program limits.

People in the latter group are being directed to buy health insurance plans on Pennie, the state’s health insurance marketplace.

Advocates at Put People First! PA, a human rights organization that broadly champions universal health coverage, are encouraging people to submit appeals if and when they get cut from Medicaid, especially for paperwork issues.

Harrison Farina, an organization leader, said he knows how difficult the application process can be. He’s been enrolled in Medicaid since 2019 and said the pandemic-era rule that waived renewal requirements these past couple years was a relief.

“It just meant I didn’t have to worry about that,” he said. “I could keep getting my health care and I would know it was stable.”

Since April, Farina has been dealing with his own Medicaid paperwork and helping others who may face other barriers to completing the process.

Thea Reimel, who lives in Philadelphia, had to submit her renewal information last month while living in a homeless shelter.

“I couldn’t do it over my phone. I had to go to a library, sign up for a library card just so I could use the computer,” she said. “It kept shutting down every so many minutes and I’d have to hope and pray that my information was saved.”

Pileggi said the entire process can be even more difficult for anyone whose first language is not English. The state provides Medicaid renewal materials in different languages online and upon request.

Pennsylvanians have up to 90 days to file an appeal or request a reconsideration following a termination notice. Only people who file in the first 15 days get to keep their Medicaid coverage during a pending appeal.

While many cases get resolved quickly, Pileggi said some can take up to three months or longer to get a final determination, and people may not have health insurance coverage during that time.

“They [the state] should give people extra time to get those appeals in, more than just 13 to 15 days, so that people can stay connected to health care while they move through this potentially very lengthy appeal process,” Pileggi said.

For information about Medicaid renewals and support services in Pennsylvania, New Jersey, and Delaware, check out our resource guide here.