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With major Medicaid changes ahead, advocates want to see increased staffing for assistance offices

Amy Sisk
90.5 WESA
State human service officials say they have taken up an aggressive outreach effort to let recipients know about the coming changes to Medicaid.

A group of health advocacy organizations are asking the state to improve staffing at county assistance offices, as well as to make other administrative changes the advocates say will lessen the likelihood of people losing their health coverage once the state starts “unwinding” its pandemic-era Medical Assistance.

During the pandemic, individuals who got their health care coverage through Medicaid – the joint federal-state program that provides health insurance for many low-income and disabled people – were mostly allowed to remain enrolled in the program without completing the re-enrollment paperwork recipients must normally complete every 12 months. Enrollment in Pennsylvania’s Medicaid program has grown by roughly 800,000 people statewide during this time.

But those pandemic enrollment rules will end April 1, and the state will have an enormous and unprecedented administrative task of redetermining eligibility for more than 3.6 million Pennsylvanians.

State human service officials say they have taken up an aggressive outreach effort to let recipients know about the coming changes; that no one will lose coverage without having an opportunity to complete renewal paperwork; and anyone who is no longer eligible for Medicaid will be offered an opportunity to get low-cost coverage on Pennie, the state’s healthcare marketplace. Officials also say they’ve continued to send renewal paperwork, they just haven’t removed people from the program for not completing it.

“No one will be automatically disenrolled from coverage when the continuous coverage requirement ends. All people covered by Medicaid will have the opportunity to complete a renewal or provide an update to their case information, and coverage will only be ended if a person becomes financially ineligible or if they do not return a renewal packet,” said Brandon Cwalina, a spokesman for the state Department of Human Services.

As to how many people are now no longer eligible? State officials said as of January, of the more than 3.6 million total people covered by Medicaid in the commonwealth: 617,000 individuals might now be ineligible and 598,000 have not completed their most recent renewal. There is some overlap in these two groups, DHS officials said.

Still, advocates say they are worried, in part because, before the pandemic, so many eligible people lost their Medical Assistance regularly due to renewal paperwork problems. Those problems will only be heightened with the volume of renewals the state will have to process, they say.

“We remain very concerned about the enormous administrative workload the County Assistance Offices will face when redetermining eligibility for this large volume of cases while resuming regular operations after 3 years, and how that is likely to translate into individuals losing coverage, though remaining eligible,” advocates wrote in a letter earlier this month to Acting Department of Human Services Secretary Valerie Arkoosh.

The letter was signed by officials from the Pennsylvania Health Access Network, the Pennsylvania Health Law Project, Pennsylvania Partnerships for Children, the state chapter of the American Academy of Pediatrics, and several other organizations.

Pre-pandemic, about 55% of Medicaid renewals in a given month would result in a termination, the advocates said. However, 89% of those who terminated would reenroll within four months – meaning they were still eligible for the assistance. “This ‘churning’ on and off of eligible people creates expensive burdens for the state by requiring the [county assistance offices] to needlessly process reapplications and creates hardship for recipients who go months without access to the benefits they are eligible to receive,” they wrote.

The group is asking the state to improve staffing at county assistance offices, (which, despite their name, are state-run).

“County Assistance Offices across the state are experiencing high rates of staff vacancies and wait times at the Customer Service Centers are long and growing. More staff will be required at both the CAOs and the Customer Service Centers to effectively handle the onslaught of work this Spring and over the following 12 months,” they wrote.

The Department of Human Services didn’t give specific staffing figures, but said it is seeing “a marginally higher-than-average vacancy rate” in assistance offices, “in line with what other human services employers have experienced over the course of the pandemic.”

There are hundreds of caseworker vacancies statewide, said Steve Catanese, president of the Service Employees International Union Local 668, which represents caseworkers in every county of the commonwealth. He said most public sector employers are struggling with staffing right now.

“Workers in these offices are going to be handling an influx of casework. It’s paramount that the commonwealth confronts this moment with an understanding of the challenges it faces and looks at making some big and bold changes in order to recruit and retain quality public servants,” he said. Catanese said state officials have discussed with the union the ways to best handle the coming influx of work.

Advocates are also asking the Department of Human Services to guarantee children can keep their coverage for another year, and to hold off on a planned change that would transfer eligibility determinations for the Children’s Health Insurance Program (CHIP) from contractors to county assistance offices on April 1. That added influx of new enrollees would add even more potential problems, they said.

The advocates are also asking the state to publish more data related to the Medicaid “unwinding” process; DHS has said it plans to do so. The state also said it will try to do more to use electronic data it already has when possible to verify a household’s income.

“We share the advocates’ goal of keeping people covered, and we are seriously considering all of these recommendations to see what can be implemented,” said Ali Fogarty, a department spokesperson.

For more information on the changes, visit the state DHS website.

Kate Giammarise focuses her reporting on poverty, social services and affordable housing. Before joining WESA, she covered those topics for the Pittsburgh Post-Gazette for nearly five years; prior to that, she spent several years in the paper’s Harrisburg bureau covering the legislature, governor and state government. She can be reached at or 412-697-2953.