Statewide COVID Restrictions: How you may be eligible for Medicaid
As we've all seen, 2020 is an unprecedented year. The hope being we come out the other side and are able to rebuild. The American spirit tells me we will.
We've had to witness several businesses in our backyard who weren't able to keep the doors open, or are holding on by the skin of their teeth. Covid round one, as I call it, spanning March to May was met with several challenges. Unemployment programs, PPP, EIDL, and several grant programs carried the load for many. Once that support ended we saw business accounts with reserves once earmarked for expansion, exhausting these reserves to keep the lights on. Fast forward to now, and more than ever we need to lean into one another to get through round 2. The house and senate haven't been able to agree on a new stimulus package and company reserves are squeezed further than we had ever thought.
Gov. Wolf's 12/12/2020 Mandate
Regardless of politics, the most recent news from Governor Wolf's office stressed a need to shut down many industries until January 4th in an effort to thwart further COVID outbreaks. To try and find a silver lining in these uncertain times PAHA realized this may be an opportunity to try and help those communities who are keenly aware of their current cash flow needs and concerned about where their next check will come from.
The silver lining is that as income changes and expenses grow, we may have a way to take one of those expenses off your plate: health insurance. After all, it's what we know. We realized that the Department of Health specifically looks at your immediate situation when it comes to Medicaid. Whether you are a server, a restaurant owner, or a line cook. Whether you are a sound guy at the local theatre, a college sports coach, or a fitness trainer at the local gym. Regardless of your industry, if your income relies on being in person, this moment in time impacts you. With a forced mandate to shut down, this is a time where your income, especially on paper, is low compared to your historic income.
The Medicaid system takes a look at the fact that you are out of work with no current income and will offer you a medical plan that is $0 premium, $0 deductible, $0 coinsurance and $1 and $3 copays. The system extends to you mental health benefits if you need to see a therapist. It gives you emergency room care if you want to make sure that the chest pain you have is no more than stress. The system gives you the ability to fill your medicines at $1 copays while you are figuring out life. And it gives you access to dental and vision benefits in case you've been putting off self-care to save every penny during these times.
This is what Medicaid was designed for. Since there are several pitfalls along the way, we thought we'd what we know to help you get the coverage you so desperately need at the price you can afford ($0).
A Basic Primer on Medicaid in Pennsylvania
As you may already know, Medicaid is a federal and state program that helps patients with limited income or resources pay for their medical costs. In Pennsylvania, Medicaid is also known as Medical Assistance (“MA”).
Who to call and where to go?
Medicaid is a government-run program run by the Department of Health(DHS) at the local(County Assistance Office), state (DHS Statewide), and federal(CMS) levels. It may seem confusing at first, but applications are submitted through the state through a program called Compass and then directed to your local county for review and processing.
Get started by completing an application at https://www.compass.state.pa.us/
https://www.compass.state.pa.us/compass.web/menuitems/ContactUs.aspx?Language=EN has several important contact numbers for you as well
Looking at Income
Ultimately, single adults aged 19 to 64 with incomes at or below 138 percent of the Federal Income Poverty Guidelines are likely eligible for MA. The U.S. Department of Health and Human Services provides a helpful table showing the Federal Income Poverty Guidelines.
When determining income thresholds in the first camp, MA in Pennsylvania doesn’t care about assets. Instead, eligibility is determined by your taxable income and household size. Income can include everything from wages and interest to dividends and social security. Things that aren’t considered income include Roth IRA distributions, living off savings, and monetary family gifts.
I've applied, now what?
Once you have submitted your application, within 2 weeks the state will route your application to the county that you live in and you will be assigned a caseworker. This caseworker has 30 days from your application date to put their seal of approval. Rather than waiting for that caseworker to be assigned, it's good to be proactive. Each county has a dedicated phone number that you can call to request a status. I wouldn't hold my breath trying to get someone. Unfortunately, most of them are prompts that circle you back to the menu every time without getting a live person. Instead, call the state. Their number is 1-800-692-7462 and they have a dedicated team that can check in on your application at the local level.
You can either email your documents to the
county or upload them directly to compass.
We prefer email so that we have a timeline for proof if the county argues they didn't receive a document. They are understaffed dealing with unprecedented applications. They are doing their best. It's not unheard of that something on the fax winds up in the shred bin. We don't blame them for this, we've just learned to accept it.
The caseworker is going to want to verify your income, since after all, that is the basis of why you are applying. Writing a letter of explanation and signing and dating it ahead of time helps give them some clarity beyond the application as to why you are applying for coverage. This letter should include your case number if you have it on compass, or your social security number so it can be matched up to your file correctly. It should have the date and your physical signature so that they can document that you have attested to your explanation. We recommend sending this before the caseworker even asks so that they can expedite your approval.
You’re Eligible? Next steps…
Once eligibility comes through they typically retroact coverage to the date you submitted your application. They will mail you a welcome packet and a yellow access card. This card is a temporary card while you pick your plan with the state. It's like a statewide slush fund to cover expenses while you get into the carrier you want.
Most counties have multiple insurers to cover the doctors that you wish to visit. You can click on this link to learn more. Under the Choose tab, you can look up your doctors at any point to make sure the plan you are going with will have them in-network. You can also go to our important links resource tab if you are trying to pull the Member Handbook for any carrier to see what they cover.
Once you've narrowed down your choices, calling enroll now to lock in your plan is a must. Otherwise, they will automatically assign you to an insurer that may not be your first choice.
If I go back to work will I be bumped off?
The last thing we will say is that through our contacts at the Department of health, we've been told that they are keenly aware that these are unprecedented times. They have been instructed to not remove people from Medicaid because income fluctuations that cause people to be added, then removed, added, then removed again causes more strain than keeping things stable for the time being. Medicaid approval should give you a solid 6 - 12 months without having to worry about your health on top of all of the additional pieces on your plate. We hope this guide at least gives you clarity.
Where do we fit in?
As a community-based organization, we do have our own compass login and process Medicaid applications for our clients. For many of our clients, they hire us to assist them to navigate this system. We normally charge an application fee of $120 for the workload (10+ hours to process) associated with managing Medicaid. We have offered everything you'd need to get approved above. If it's just too much of a task that you'd want help, our team is cutting our fee in half to $60. The full amount will be going completely to the processor who works with you and your caseworker to get your application approved. PA Health Advocates will have no economic benefit from this service. Instead, our hope is that between the guidance above and our team that is passionate about helping the communities we serve that you can benefit from this silver lining.
If you want us to help, complete our intake here. In the "Additional Information" section please add "$60 Medicaid Assistance" so that we can add you to our system and get in touch with you asap!
Joshua Brooker, REBC, ABHP, ESP
PA Health Advocates