What Your Medical Assistance Patients Need To Do and How You Can Help

As you know, the Pennsylvania Department of Human Services (DHS) was able to keep Medical Assistance (MA) coverage open for most people during the COVID-19 Public Health Emergency (PHE) even if they were no longer eligible for MA. DHS is now in the process of making sure that everyone who is receiving MA is still eligible by reviewing each person’s information.

When your patients who are on MA receive their renewal paperwork from PA DHS, they must complete and submit their information. If they do not, they will lose their MA coverage.

Once a Participant completes and submits their renewal paperwork, PA DHS will determine eligibility, which results in one of two scenarios:

  1. If they remain eligible, they will continue to receive health care coverage through AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices (CHC). There is nothing they need to do to continue coverage with us.
  2. If they are found to not be eligible for MA, they will no longer have coverage through AmeriHealth Caritas PA CHC. We can help them find other possible options, if needed.

Encourage your MA patients to take action now

What to do How
Make sure their address and phone number are up to date with DHS
Complete their renewal information and return to DHS by the due date
  • Online: www.dhs.pa.gov/COMPASS
  • Mail: to your County Assistance Office
  • Phone: 1-866-550-4355
  • In person: go to your County Assistance Office
Sign up for alerts from DHS TODAY
Get more information about the PHE

Start the conversation with your MA patients and stress the urgency of timely submission of their renewal paperwork by using any of the tools listed below.

New to the NaviNet provider portal

  • Participant Annual Eligibility Redetermination Popup Alert
    In the Eligibility and Benefits screen under the Patient Alert Details pop-up, there will be a new Redetermination Report link that, when clicked, will display the Participant’s upcoming eligibility redetermination date. The new pop-up alert will be very similar to the existing Care Gap and PCP History alerts and will be available to all provider types.
  • Participant Annual Eligibility Redetermination Report
    In the Administrative Report Inquiry section, a new report will be available for PCPs under the report list drop-down menu that provides a full list of all Participants on your roster who have upcoming eligibility redetermination dates (within the next 90 days). The report will be available for PCPs to download in both PDF and Excel formats.

Quick tip checklists

  • Tear-off lists are available for you to give to your patients. The lists tell Participants what they need to do and where they can go if they need help or have questions.
  • If you need these, please let your Account Executive know.

If you have any questions, please contact your Provider Account Executive or Provider Services at 1-800-521-6007.