Nearly one million Pennsylvania and New Jersey residents who enrolled in Medicaid during the COVID-19 pandemic could lose publicly funded health insurance, which has been a lifeline when they were unexpectedly unemployed — and uninsured — amid a novel virus made clear the importance of health insurance.
For the past three years, states have suspended rules that require people to reapply annually for Medicaid, the publicly funded health insurance program for low-income families. Beginning in April, the Medicaid renewal process will resume.
Anyone who enrolled in Medicaid more than a year ago must renew their coverage by proving they still meet the income requirements. Those who no longer qualify — or fail to complete required paperwork on time — lose Medicaid protection.
The Urban Institute, an economic and social policy think tank in Washington, DC, estimates that 494,000 people in Pennsylvania and 352,000 in New Jersey will lose their health insurance by June 2024, although many are expected to be insured elsewhere, according to a December report.
“People are really not sure what’s happening,” said Laura Waddell, the director of health programs at New Jersey Citizen Action, which helps people sign up for health insurance.
Many are new to Medicaid and unfamiliar with the program’s policy of revoking benefits if people don’t re-enroll — a key difference from employer-based private health plans, which typically renew automatically. Others may not be aware that they need to take action because the state is trying to reach them using outdated contact information.
A surge in the number of people who are uninsured is “inevitable,” said Patrick Keenan, policy director at the Pennsylvania Health Access Network, which helps people enroll Medicaid and Affordable Care Act Marketplace Health Insurance Plans.
“It’s really about making sure this happens for the shortest possible time,” he said.
Here’s what you should know about Medicaid when the COVID-19 public health emergency ends:
How will the Medicaid renewal process work?
First, it’s important to realize that the benefits of Medicaid won’t go away overnight. Pennsylvania and New Jersey expect it will take them — at least — a full year to clear the backlog of overdue renewals.
Approximately 30 days before your coverage expires, you will receive a renewal package in the mail. Complete the package and return it by post or follow the attached online renewal instructions.
Medicaid sends out notifications by mail, phone, SMS, and email to let them know their renewal deadline is approaching. Agencies are expected to start reaching out to people at least 90 days before their coverage expires.
What Questions Will I Be Asked About Renewing Medicaid?
Most importantly, you will be asked to provide proof of your current income.
The number of household members, their ages, and their employment status are all questions included in the Medicaid Renewal Questionnaire.
What steps can I take to prepare for Medicaid renewal?
Find out when your plan renewal is due by calling the Pennsylvania Department of Human Services (1-866-550-4355) or NJ Family Care (1-800-701-0710). Pennsylvania residents can use or create an online COMPASS account to check the status of their Medicaid coverage, apply for other public benefit programs, and track application progress.
update their contact information, especially if you can’t figure out when your plan will expire. Up-to-date mailing address, email address, and phone number are critical for Medicaid and the program’s community health partners to notify you when it is time to renew your coverage.
Create an accurate income estimate. Medicaid is based on current income. However, if your income fluctuates a lot, for example if you do seasonal work, you can earn significantly less in a few months than you do now. Keenan suggests making a note of this and including an estimate of the expected income, although not specifically requested.
What happens after I apply for a Medicaid renewal?
Most people will know within 30 days if their renewal request has been approved, although Medicaid has up to 45 days to notify people. If you don’t hear from Medicaid within 30 days, Keenan suggests calling to verify that there wasn’t a problem with the application and that correspondence wasn’t lost in the mail.
What should I do if my Medicaid application is denied but I believe I am eligible?
You have 90 days to appeal the decision, but don’t wait until the last minute to take action.
Look for errors that may have caused earnings to be counted twice — for example, payslips from Tom’s Pizzeria and Tom’s Pizzeria, Keenan said.
Seek help from a legal aid organization like Philadelphia Legal Aid if you don’t feel comfortable appealing yourself.
Most people retain Medicaid benefits for about a month after receiving a termination notice. It’s important to act quickly to appeal a refusal so you have as much time as possible to sign up for new coverage if you are ultimately unable to stay on Medicaid.
What should I do if I no longer qualify for Medicaid?
Individuals who lose Medicaid coverage are eligible for a special enrollment period through the Obamacare marketplaces — Pennie in Pennsylvania and Get Covered NJ in New Jersey.
Typically, you have 60 days before and after your Medicaid cancellation date to sign up for a new Marketplace plan.
“Be proactive,” said Jamie O’Brien, director of the Center for Family Services’ Navigator Exchange Program in New Jersey, which contracts with New Jersey to help people “navigate” the insurance application process. “If you are in a position to know that you are going to lose insurance coverage, come to us, let us help you.”
The vast majority of people are eligible for a tax credit to offset premium costs for marketplace plans. Tax credits vary by income and ensure no one pays more than 8.5% of their income for a mid-level plan.
Families and individuals just above the income limit for Medicaid eligibility may be able to get a marketplace health plan at no cost.
Where can I get help with Medicaid?
In New Jersey